Chapter 5. Not Enough to Be a Messenger
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101 In the early 1920s, those who would reform the US healthcare system established a small series of demonstration projects that would provide patients access to high-­ quality, cost-­ effective, and expertly coordinated healthcare. Much like the goals of those supported by today’s Center for Medicare and Medicaid Innovation , these demonstration projects would translate ideas into practices that could be easily adopted by existing healthcare structures. Many of the demonstration projects of the 1920s proved successful and many of the practices they supported proved enduring. They established the idea of a neighborhood health center as the most effective site of public health initiatives, an idea now institutionalized in the Affordable Care Act’s expansion of monies for community health centers to bring high-­ quality care to poor urban neighborhoods and isolated rural ones.1 They placed the practice of “periodic medical exams” for both children and adults as central to maintaining health and preventing illness. They set the stage for the eventual insurance coverage of exams such as mammography for women, prostate cancer screenings for men, and vision and hearing exams for children. They launched an emphasis on oral hygiene and dental care as key pillars in one’s overall health status and, while availability of service remains less than ideal, an emerging field of research and practice in oral-­ systemic health holds the potential to alter this terrain.2 These demonstrations, in fact, eventually established the current norms of primary care. And public health nurses played a critical role. They brought the messages of health into illness care even in the face of the often-­ suspicious communities they served. And they brought the norms of middle-­ class health practices to families excluded by the financial requirements of fee-­ for-­ service medicine. Not Enough to Be a Messenger Chapter 5 102 Nursing with a Message More immediately, much good came from these demonstrations. The East Harlem Health Demonstration Project proved that its community sought health and welfare information when it was easily available to them. The East Harlem Nursing and Health Demonstration Project highlighted the importance of research in the public health nursing agenda. And the Bellevue-­ Yorkville Demonstration Project showed how public and private partnerships could be successful when carefully calibrated to meet the Department of Health’s own mission and goals. Each provided different data streams that Shirley Wynne, New York City’s commissioner of health, needed as he moved to implement a system of neighborhood health centers when federal construction dollars became available in the mid-­ 1930s. Those involved in the demonstration projects constantly talked with one another and showed a certain nimbleness in stepping in to solve problems or provide resources that another lacked. But notions of “coordination” and “cooperation” were, as contemporaries recognized, always easier to conceptualize than to implement. Michael Davis, the noted reformer, told nurses at the 1939 Annual Meeting of the National Organization for Public Health Nursing that these notions demanded “imagination and courage” rather than the “protective attitude” too often engendered by ideas for change. Despite massive federal involvement in providing health and welfare services during the Great Depression, there would still be a place, he continued, for smaller, private health agencies, like the East Harlem Nursing and Health Service. But he added an important caveat. To survive, he told public health nurses that they needed the “imagination to conceive, investigate, and define what unmet needs are” and the “courage to scrap past activities and work on that somewhat uncertain and often controversial borderline which runs between the present and the future.”3 This borderline was an increasingly fraught space. Some of the tensions in this space, as historian Karen Buhler-­ Wilkerson has argued, did lie with a changing context. The closing of American borders to immigrants mitigated the need for a public health nurse to bring both “medicine and a message” of Americanization to poor families.4 Indeed, the poorest families now crowding New York City—­ those from Puerto Rico and blacks from southern states—­ already claimed American citizenship. But these claims were tenuous, complicated, and, preferably, ignored. In East Harlem, in particular, Puerto Rican families did not fit comfortably into an established, entrenched, and binary racial hierarchy . While some of the neighborhood’s politicians and activists, including Leonard Covello, found ways to form alliances with members of the Puerto Rican community, most others kept their distance. Puerto Ricans, in turn, kept their distance from blacks as a strategy to fend off further marginalization.5 Not Enough to Be...

Subject Headings

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