restricted access Chapter 2. The Houses That Health Built
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35 On November 10, 1921, New York City’s East Harlem Health Center Demonstration Project (Health Center) opened to great fanfare. The Health Center self-­ consciously characterized itself as a “department store of health and welfare” playing on the success of a new middle-­ class institution that promised everything one could imagine buying in one central location. Similarly, the Health Center gathered twenty-­ three of the neighborhood’s health and social welfare agencies into one newly refurbished building for the same kind of “one-­ stop shopping” for coordinated health and welfare services. The concept of “coordination ” was key to the success of the Health Center. Public and private agencies would keep control of their budgets and personnel; but the demonstration would test the premise that physical proximity would eliminate costly service duplication, ease access to resources needed by the predominantly Italian community , and, in the end, deliver better health outcomes.1 A little more than a year later, in December 1922, its sister demonstration, the East Harlem Nursing and Health Demonstration Project (Nursing Project), started its work with less attention but no less import. Unlike the Health Center, the Nursing Project would be an effort in controlling the distribution of nursing services in one-­ half of the East Harlem neighborhood. The three private agencies that supported specialized East Harlem nursing services—­ the Henry Street Visiting Nurse Service (VNS) that focused on nursing the sick in their homes, the Maternity Center Association (MCA) that provided prenatal and home birth services, and the Association for Improving the Condition of the Poor (AICP) that supported tuberculosis nurses—­ would pool their resources, personnel , and dollars into one controlling organization that would also construct The Houses That Health Built Chapter 2 36 Nursing with a Message a research project to prove that a generalized nursing service could more efficiently and effectively serve the needs of the neighborhood for sick nursing, provide maternal healthcare and education, and meet the health needs of the preschool child.2 And, finally, in 1926, the Bellevue-­ Yorkville Health Demonstration opened in midtown New York City. It had—­ with some “apprehension”—­ refocused its goals and agreed to an administrative arrangement that placed the health commissioner in charge and a member of his staff as the director of the demonstration . Within one year of its opening in 1927, however, the Fund found this arrangement “impossible,” with vague allusions to the “handicaps” of working within the structure of the city’s “political machine.” It again reconfigured its mission as a smaller series of demonstrations, some of which—­ like the use of chest X-­ rays in the diagnosis of tuberculosis and the provision of materials needed to maintain lung rest through induced pneumothorax—­ could be adopted later by the Health Department.3 This chapter delves more deeply into the day-­ to-­ day realities of New York City’s health demonstration projects. It explores the escalating tensions between New York City’s Department of Health and private agencies and associations over who controlled the public health agenda. These private or, as they referred to themselves, voluntary agencies publicly ceded control to the official agency that the Departments of Health represented. But privately they constantly sought ways to turn this official agency toward their priorities. In New York City, both the Rockefeller Foundation and the Milbank Memorial Fund believed public health nurses were key to this process. Indeed, the involvement of the city’s public health nurses in both East Harlem demonstration projects had been a central element in the Rockefeller Foundation’s support. It could not be a true demonstration of care control, the Foundation believed, unless it involved the city’s own public health nurses who ran the milk and infant welfare stations; who supervised the health of schoolchildren; and who implemented programs of case finding, case holding, and case control of tuberculosis and other infectious diseases. The Foundation’s policy, in the United States and abroad, was one of only working through governmental public health authorities to ensure the sustainability of its initiatives. It hoped to use a consolidated private and public health nursing system in East Harlem to ultimately do the same in New York City. Historians have long noted the tensions between public and private agencies in setting and implementing a public health agenda.4 But public health nurses held no interest in the battles at tables to which they had not been invited. More precisely, the nurses involved in New York City’s health demonstrations Figure 3.   Locations of All...


Subject Headings

  • Community health nursing -- New York (State) -- New York.
  • Public health nursing -- New York (State) -- New York.
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