Cultivating Health: Los Angeles Women and Public Health Reform (review)

This small but impressive book is a series of case studies, well researched and documented, examining the role of white middle-class women in the public health reforms in Los Angeles between the 1890s and the Great Depression. The overall thesis presents Los Angeles as uniquely exemplifying variations on private–public initiatives to improve public health. The women and their organizations developed various reform efforts that interacted with existing political and administrative structures to influence public health reform. Koslow demonstrates the value of local experiments in reform as models for national reform, speaking specifically to the present national debate on health care reform. She examines the development of public health nursing, housing reform, food safety, obstetrical services, and venereal disease control, detailing the role of women’s reform efforts in each. These efforts occurred in the face of tremendous population growth and diversification in the setting of economic boom and bust. Issues of gender roles, scientific advancement, male-dominated political structures, class conflict, and racial and ethnic cultural dynamics are presented as a backdrop for the lives of specific reformers and the public with whom they interacted.

The book is well written, scholarly yet personal, in that specific actors come to life as they struggle to improve living conditions or simply survive. This is especially seen in the chapters dealing with milk reform and venereal disease control. In the former, the ideologies of two civic-minded women, one from privilege and the other from the working class, come into conflict over efforts to ensure that milk was free from bovine tuberculosis versus the projected rise in the cost of milk as a result of such legislation, which would place it out of reach of many poor women. In the latter chapter, public-minded women are pitted against sex workers, as issues of public safety versus state control over individuals and their bodies are played out. In another chapter, the traditional role of women as midwives is challenged by the male-dominated medical establishment, as midwives are erroneously seen as the cause of the tragically high infant and maternal death rate. In this drama, women reformers play a pivotal role in negotiating change. Each chapter presents an informative variation on the interactive dynamics of the various economic, cultural, political, and demographic factors. The complexity of each case is gradually developed over time, as compromise and negotiation results in varying degrees of public health reform.

Like all good books this one raises more questions than it answers. However, certain details are missing. For instance, in the chapter on housing reform, the focus is on the “house court,” but nowhere is this expressly described. Throughout the book, issues of culture and ethnic diversity are touched on, but rarely are cultural factors explicated. For instance, in the introduction, an illustrative vignette is presented in which a public health nurse struggles to administer to a Russian immigrant family. It is very tempting to speculate that the family’s having escaped from czarist Russia may have played a large role in their distrust of health care institutions. In many chapters, Mexican immigrants are the focus of fears of contagious disease and subsequent health care initiatives. There is, unfortunately, little on the role of Mexican culture or the Catholic Church in this process. This may be an issue of documentation, discipline, or emphasis, but it is important, because the author presents the reform-minded women and the public health nurses as negotiating between the government and health care institutions and the vulnerable, poor populace. Many details are given about the city institutions, but little on the lives of the latter and their role in this process as they interacted with and possibly influenced the white middle-class women working for reform and improved health care.

This is a fine book that will add to our understanding of the development of health care in this...