Making ends meet.


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Making ends meet.

  1. 1. PUBLIC HEALTH THEN AND NOW Making ENDS Meet Community Networks and Health Promotion Among Blacks in the City of Brotherly Love| Margo Brooks Carthon, PhD This historical inquiry illustrates the power of social networks by BLACK AMERICANS HAVE public health practitioners, aware examining the Starr Centre and the Whittier Centre, two civic as- historically experienced worse of the relationship between poor sociations that operated in Philadelphia during the early 20th health outcomes and much lower health and social conditions, initi- century, a time when Black Americans faced numerous public life expectancy than have their ated campaigns to decrease urban health threats. Efforts to address those threats included health White American counterparts. blight and prevent communicable initiatives forged through collaborative social networks involving These trends, although notable diseases. These programs, how- civic associations, health professionals, and members of Black today, were equally prevalent ever, often failed to adequately communities. Such networks provided access to important nearly a century ago, when Blacks address the needs of growing resources and served as cornerstones of health promotion ac- faced persistent health threats urban Black communities. Hence, tivities in many large cities. I trace the origins of these two cen- ters, the development of their programs, their establishment of because of the cumulative impact left with a scarcity of resources ties with Black community residents, and the relationship be- of infectious diseases, poverty, from municipal agencies, Black tween strong community ties and the development of community and limited health resources.1 community members turned health initiatives. Clinicians, researchers, and community health During the second decade of the inward toward their own private activists can draw on these historical precedents to address con- 20th century, stark disparities in civic associations to meet their temporary public health concerns by identifying community health between Blacks and Whites health and welfare needs.3 strengths, leveraging social networks, mobilizing community mem- drew the increased attention of Civic associations during this bers, training community leaders, and building partnerships with public health officials in northern period were characterized by indigenous community organizations. (Am J Public Health. cities as large numbers of rural progressive ideals and an agenda 2011;101:1392–1401. doi:10.2105/AJPH.2011.300125.) southern Blacks left agricultural of social reform. As Smith and settings in search of jobs and Hine demonstrate in their work increased social freedom in the on Black club women, these north.2 Upon their arrival in social welfare organizations laid northern metropolises many of the roots for the implementation their dreams were dashed as they of many large-scale public health encountered substandard housing, reform initiatives.4 For Blacks in hazardous working conditions, the early 20th century, member- and poor sanitation. A number of ship in civic associations such as1392 | Public Health Then and Now | Peer Reviewed | Carthon American Journal of Public Health | August 2011, Vol 101, No. 8
  2. 2. PUBLIC HEALTH THEN AND NOWmission societies, charity organi- development and operation of health. Many of the norms, values,zations, churches, women’s clubs, community health programs war- and institutional infrastructuresmutual aid societies, and benevo- rants more attention. The accom- present in Black communities inlent associations provided access plishments of many community the early decades of the 20thto important public services and health programs depended on a century remain in place today.a network of social support. civic association’s ability to estab- Thus, a fuller appreciation of theBecause of their long-standing lish a sense of group cohesion dynamic and reciprocal naturework in many Black communi- and trust among community of these relationships can serveties, civic associations held posi- members. This was particularly as templates for public healthtions of prominence in those true among members of Black activists who strive to createcommunities, helping to form the communities, who for centuries sustainable health coalitionsfabric of social order by promot- relied heavily upon institutions among diverse communitiesing messages of uplift, thrift, and such as churches and benevolent today. Moreover, Black communi-personal responsibility. Most civicassociations were financed bydues collected from their constit-uents or by contributions fromwealthy donors and were locatedin poor immigrant and Blackcommunities. Several offeredhealth services through dispensa-ries or by nurses who were hiredto provide care in the home.5 The popularity of civic associa-tions grew steadily during theProgressive Era because theyoffered a wide variety of services.For the Blacks they served, civicassociations brought relief fromthe often complex burden of ill-ness, social isolation, and eco-nomic need. Blacks experiencedhigh rates of tuberculosis (TB),so they were interested in civicprograms pertaining to health societies to meet their health, ties continue to experience health Cooperative Coal Cluband disease prevention. These social, and welfare needs. Here I disparities in the form of dispro- Source. Starr Centre, "Annual Report," 1911.programs were primarily focused describe support networks devel- portionate rates of HIV/AIDS Reprinted with the permission of the Barbara Bates Center for the Study of the History ofon health promotion, but they oped with the aid of two civic and other chronic illnesses. If a Nursing, University of Pennsylvania.also provided opportunities for associations—the Starr Centre central tenet of public healthmiddle-class and working-class and the Whittier Centre—to sup- activism is the engagement ofBlacks to socialize with one port Blacks in Philadelphia, Penn- local residents in the developmentanother and with White philan- sylvania, during the early 20th and implementation of health ini-thropists in the larger community. century. I highlight the origins tiatives, then this case study isOver time, relationships between and programs of the associations, valuable because it highlights thecommunity members of diverse their establishment of ties with benefits of these efforts.racial and class groups led to a the Black community, and thegrowing sense of civic unity and relationship between building THE STARR CENTRElaid the foundation for the subse- strong community ties and the CREATES EARLY TIESquent development of a number development of health initiatives.of community health initiatives. The events examined here In the early 20th century, Phil- Civic associations have long occurred a full century ago, but adelphia experienced a cataclysmoccupied a prominent position in they hold lessons applicable to of immigration in the midst ofUS society, and their role in the 21st-century issues in public rapid industrialization. Like otherAugust 2011, Vol 101, No. 8 | American Journal of Public Health Carthon | Peer Reviewed | Public Health Then and Now | 1393
  3. 3. PUBLIC HEALTH THEN AND NOW northern cities during this period, civic-improvement efforts By the time of his death in Philadelphia witnessed an launched by its benefactor, 1884, Starr’s social-welfare initia- upsurge of immigrants and rural White social progressive Theo- tives were well entrenched within Blacks migrating from the south. dore Starr (1841–1884).9 Philadelphia’s Black community. Between 1890 and 1910, the During his lifetime, Starr was Starr’s legacy continued through city’s Black population increased recognized as a keen business- the efforts of several long-time more than 100%, to 84 000, in man and philanthropist with a acquaintances, including Susan a city with a total population of deep commitment to poor Black Parrish Wharton, a well-known 1.5 million; by 1920, the Black and immigrant families living in community member and civic population grew to 134 000 in the fourth, fifth, and seventh activist. When the Starr Centre a total population of 1.7 million.6 wards of Philadelphia. His con- was founded in 1897, Wharton As Philadelphia’s newest residents cern for the social welfare of served as chairperson and presi- packed into cramped dwellings, local residents led to the develop- dent. Wharton and her colleagues TB and other infectious diseases ment of a number of initiatives, stated that the Starr Centre Asso- gripped the city, and housing including public playgrounds and ciation’s aims were conditions began to rapidly deteri- gardening centers for neighbor- [to] provide for and promote by orate.7 Progressive reformers hood children. Starr’s desire to practical methods, the educa- battled the growing threat of improve the quality of life for tional and social improvement infectious disease and urban decay local Blacks led him to establish of those poor neighborhoods; primarily in the vicinity of the by establishing a variety of chari- Philadelphia’s first Progressive Starr Garden.11 ties, including settlement houses, in Working Colored Men’s Club which middle-class volunteers lived (1878) and the city’s first Penny The settlement operated with as settlers in low-income areas Bank (1879), where Blacks could a modest budget and consistedCoal Club, "Ready for the Lecture and worked to serve the poor.8 save small amounts of money to of a board of directors, donors,to Begin" During this turbulent time be used for planned purchases various committees, and neigh-Source. Starr Centre, "Annual Report," 1906. the Starr Centre, a settlement later. Starr also purchased plots borhood residents. The StarrReprinted with the permission of the BarbaraBates Center for the Study of the History of organized in 1897, became a of land that were used to build Centre’s programs includedNursing, University of Pennsylvania. clearinghouse for the numerous affordable homes for Blacks.10 classes in domestic art and carpentry, the provision of inex- pensive lunches and milk for schoolchildren, health lectures, visiting nursing services, and dispensaries for medical care.12 Local residents gained access to association membership by con- tributing one dollar annually. Over the course of the next decade, Starr Centre programs increased in popularity among local immigrant and Black families.13 Starr Centre leaders were par- ticularly interested in health pro- motion and disease prevention. In 1905, the Starr Centre created a medical department and con- tracted with the Visiting Nurses Association of Philadelphia to provide nursing care to sick children and adults in clinics and homes.14 Despite the excessive ill- ness present in the Black commu- nity, many families were forced1394 | Public Health Then and Now | Peer Reviewed | Carthon American Journal of Public Health | August 2011, Vol 101, No. 8
  4. 4. PUBLIC HEALTH THEN AND NOWto juggle their participation in the Coal Club’s members repre- from 300 to 400 individualshealth programs and visits to sented a cross section of working- would assemble to hear healthlocal clinics with more quotidian class and middle-class Blacks lectures and to discuss clubdomestic concerns, such as find- who were unlikely to meet in affairs. Like other mutual aid anding coal to warm their homes or other settings because of different benefit societies, the religious,food to fill their children’s hungry class or church affiliations.18 In secular, social, and political pur-stomachs. Even as infectious dis- the opinion of Susan Wharton, poses of the Starr Centre and theease rates spiked among Blacks, manager of the Coal Club, this Coal Club sometimes overlapped.poor families were frequently convergence of individuals from Meetings called to discuss theobliged to work long hours different social strata and denom- cost of coal were often followedinstead of seeking medical care. inational affiliations was of signifi- by singing hymns, enjoyingStarr Centre board members saw cant value, for common concerns refreshments, and socializing.22this dilemma and realized that emerged in During these gatherings, mat-any efforts to curtail excess sick- ters pertaining to illness and mak-ness had to address the limited [the] pulling together and . . . ing provisions for poor health good fellowship growing upmaterial resources of community were commonly discussed. A among people of varied occupa-members first.15 tions and interests and belonging recurring topic among club mem- to many different churches.19 bers was the lack of good medicalBuilding Community and nursing services.23 AlthoughResources The Coal Club’s open mem- the city’s Blacks could seek care One of the Starr Centre’s early bership policy allowed it to serve from local health departments,efforts to address the pressing as more than just a way to obtain neighborhood health centers, andeconomic needs of Black commu- necessary material resources; the city hospital (Philadelphianity residents began with the ini- over time it helped foster a General Hospital), treatment andtiation of the Cooperative Coal diverse set of social networks services at these facilities wereClub. The Coal Club was created among its members. often of limited availability andas a way to help Blacks by offer- From the early years of its poor quality. Philadelphia Gen-ing them protection from unscru- inception throughout the first eral Hospital, for instance, waspulous merchants who were decade of the 1900s, the Coal frequently overcrowded and inknown to sell coal at inflated Club’s membership steadily grew, disrepair. Philadelphia’s twoprices.16 Many Black city resi- as did the number of club-spon- Black-run hospitals, Frederickdents relied on hard coal as a fuel sored functions. Prompted by the Douglass Memorial Hospitalsource for cooking and heating club’s growth, the Starr Centre (established 1895) and Mercytheir homes. Meager weekly purchased a second property at Hospital (established 1907),wages, however, forced poor and 18th and Webster Streets in extended services to Blacks, butworking-class families to buy coal 1911 that was soon recognized neither hospital had beds forin small amounts. Buying coal in as a central meeting space for patients infected with TB, so theythese small bucket portions often Blacks living in the community.20 were unable to meet this criticalmeant paying higher costs per Coal Club members used the need among Philadelphia’s grow-pound. The Coal Club offered a newly purchased house for ing Black community.24way out of this trap by allowing monthly social and business pur- Faced with the constant threatmembers to form a cooperative poses, and frequently stopped in of illness, Coal Club membersfor the purpose of buying coal in for social calls and to seek advice worked with Starr Centre organiz-large quantities, thus bringing from Starr Centre staff.21 The ers to form the Rainy Day Societydown the price.17 space was also used for monthly in 1905. Similar to many other The Coal Club drew its mem- Coal Club meetings attended by sick benefit societies in citiesbership from the area south of women, men, and children from across the country, the Rainy DayLombard Street and reflected the across the community. These Society served as a safety net fordiverse backgrounds of Blacks meetings provided a venue for its members by providing financialliving there. Unlike some frater- fellowship and discussion of protection against the devastationnal societies and social clubs, important community topics. At that unexpected illness caused.which offered membership to larger monthly gatherings, often Individuals joined the Rainy DayBlacks on an exclusionary basis, held at local churches, anywhere Society by paying annual duesAugust 2011, Vol 101, No. 8 | American Journal of Public Health Carthon | Peer Reviewed | Public Health Then and Now | 1395
  5. 5. PUBLIC HEALTH THEN AND NOW over the course of the year in inspire.”28 In 1911, the Rainy approach the Starr Centre board small weekly payments. An Day Society and Coal Club of directors with a plan for all-White staff of paid Starr Centre together had more than 900 expansion. In a meeting on May visitors collected the payments by paid members, and visitors that 28, 1912, board members dis- making personal calls to the home year made more than 41 000 cussed the merit of Wharton’s of each member. At each visit the home visits.29 Members fre- “Plan for Readjustment,” which typical payment was 10 to 15 quently asked visitors to “please was designed to increase the ser- cents. Monies received from Rainy call on my aunt, who wants to vices that the Starr Centre Day Society members were join” or “my cousin or friend.”30 offered specifically to the Black deposited into the Starr Savings The Starr Centre’s philosophy of community. After lengthy discus- Bank and kept in a trust for mem- “active touch” between the sion, the board resolved that it bers in the event that they had an trained visitors and Coal Club would be unwise to undertake an emergency that required use of and Rainy Day Society members expansion of its work for Blacks, the funds.25 Society members helped to foster a “mutual under- though it hoped to continue pro- could also withdraw their total standing and confidence,” result- viding such services at its present savings at the beginning of each ing in an inspiring partnership pace, with their “growth encour- year for other purchases. that would endure.31 aged at a normal but steady man- In time, the small amounts of What did it mean for White ner.”33 The decision for limited savings contributed by club visitors to have such open access expansion did not indicate an members steadily grew in value. to the homes of Black club mem- unwillingness to provide services In 1905, visitors made 6394 bers? Certainly there was the risk to Blacks; rather, it reflected a home-collection visits, through that interracial and class tensions reluctance to try to increase which Rainy Day Society mem- might emerge during these inter- them. It must be recalled that the bers collectively saved $967. By actions. Indeed, other historical Starr Centre was never intended 1909, those figures had dou- examples of interracial settle- to address the needs of Black res- bled.26 One society member said, ments and civic associations dur- idents exclusively, and such an “I tell you this saving thing is a ing the same period reveal expansion might have threatened great thing; when sickness comes, significant discord between asso- or undermined the center’s out- you have the money, when death ciation leaders and Black mem- reach to other poor or immi- comes, you have the money, and bers.32 Conversely, the Starr grant constituents of south when you want to . . . go down Centre appears unique because Philadelphia. home [south] you’ve got the of the absence of overt class and On June 11, 1912, the matter money for that.”27 racial bias in its annual reports. Its of expansion of services in the Most of the members of the records instead display the condi- Black community was again Rainy Day Society were also tions that allowed these weekly taken up at a Starr Centre board members of the Coal Club. This interactions to solidify the bonds meeting in which it was unani- dual affiliation allowed members of trust and mutual respect, set- mously carried that: to access a range of services ting the groundwork for the sub- if an independent agency, as formed to address material and sequent development of other capable as ourselves of carrying health needs. The Starr Centre health initiatives. As visitors on effectively the present objec- coordinated its services with the became eyewitnesses to the con- tives of the Coal Club and Rainy Day Society be formed, we Coal Club and the Rainy Day ditions and home lives of club should be willing to consider a Society through frequent visits to members, they took with them a transfer to that organization of the homes of club members. deeper knowledge of the needs our work in connection with in- dividuals living out of the Starr While in members’ homes, Starr of Black residents that then Centre neighborhood.34 Centre visitors were charged with translated into the programmatic collecting dues, learning about efforts of the Starr Centre. On October 8, 1912, Wharton members’ living conditions, and tendered her resignation as offering assistance or referrals Growth and Division founding member of the Starr when needed. By building rela- In 1912, the ever-present Centre board. Within the month tionships and offering “constant needs and continued growth of following her resignation, the sympathy and care,” trained visi- south Philadelphia’s Black com- board voted to allow Wharton and tors hoped “to help, to advise, to munity prompted Wharton to her newly formed association, the1396 | Public Health Then and Now | Peer Reviewed | Carthon American Journal of Public Health | August 2011, Vol 101, No. 8
  6. 6. PUBLIC HEALTH THEN AND NOWWhittier Centre, to assume respon-sibility for all operations of theCoal Club and the Rainy DaySociety.35THE WHITTIER CENTREEXPANDS SOCIALNETWORKS As a newly formed civic asso-ciation, the Whittier Centre wasestablished with the primary aimof addressing the social andhealth needs of Philadelphia’sgrowing Black community. Theseefforts began in earnest in the fallof 1912 when Susan Whartonand several other prominent Phil-adelphians established the centerat 712 South 18th and 510 South7th Streets within the heart of activists and medical professionals were able to see so many people Elizabeth Tyler, RN, with members ofthe city’s historic Black district. in prominent positions. This strat- because so many club members the Little Mothers Club.Named after 19th-century poet egy was essential to the sustain- either lived together in the same Source. Whittier Centre, "Annual Report," 1915.and abolitionist Greenleaf Whit- Reprinted with the permission of the Urban ability of the Whittier Centre’s houses or lived in close proximity Archives, Temple University Libraries.tier, the new association’s mission goals and objectives, which to the center.was to create practical solutions included “calling on the race to Whittier Centre leaders wereto the social problems plaguing help itself.”39 Beyond this aim, the especially concerned with exces-the Black community.36 Wharton center’s Black leaders, as mem- sive TB death rates in the Blackserved as the Whittier Centre’s bers of the targeted community, community. In 1900, the TBfirst treasurer. Henry R.M. Landis, served as mediators and cultural mortality rate among Philadel-a prominent physician associated brokers between the Whittier phia’s Whites was 197.3 perwith the Henry Phipps Institute, Centre and the communities it 100 000; among Blacks, the rateserved as the centre’s first presi- was intended to serve. was 447.0 per 100 000.43 Indent.37 The rest of the board of The Whittier Centre’s early 1910, TB deaths among Blacksdirectors consisted of five physi- programs were directed toward were 57% higher than among thecians, one member of the clergy, the active members belonging to city’s native-born Whites andand five female volunteers. the Coal Club and Rainy Day 44% higher than among the city’s A group of 18 individuals Society and to individuals living foreign-born Whites.44 Despitemade up the Whittier Centre’s in the squalid alleyways around excessive illness rates, Blacks hadadvisory board. Henry Minton, a the city.40 During its first year, limited treatment options. Localwell-known Black physician, was the Whittier Centre continued hospitals and private sanitariumsadded to the advisory board in the tradition of home visits to often placed restrictions on admis-1915. Booker T. Washington Jr, club members, making 42 642 sions of Black patients.45 Addingson of the famous Black educator visits in 1912 and 1913.41 Whit- to the problem of limited healthand author, joined the Whittier tier Centre visitors were viewed care was low Black patient utiliza-Centre as executive secretary in as neighbors who were trained tion of those services that were1919 to assist the organization in available. When TB beds were [to] get behind the scenes to de-addressing the housing concerns termine not only the external available, some Blacks refused toof Black community residents.38 facts but conditions that make leave the comforts of home for physical and moral deterio-The Whittier Centre’s racially because they feared the treatment ration.42integrated governance structure they would receive from strang-exemplified the organization’s Visitors frequently provided ers.46 One TB health officialcommitment to placing Black services to entire families. They noted thatAugust 2011, Vol 101, No. 8 | American Journal of Public Health Carthon | Peer Reviewed | Public Health Then and Now | 1397
  7. 7. PUBLIC HEALTH THEN AND NOW [Black residents] did not avail autopsy in the event that the the care of Black patients at the themselves of the benefits of patient should die while on the dispensary.55 In the Phipps Insti- dispensaries, or if they did, made but a few visits, often but ward.53 Although this policy tute’s first year of working with one, and then ceased coming.47 undoubtedly was intended to the Whittier Centre, the number ensure the advance of scientific of Black patients visiting the Aware of the threat of TB, the inquiry, it did little to boost the clinic was twelve times higher Whittier Centre executive com- confidence of Black community than in the previous 11 years mittee met on May 14, 1913, to members, who were likely suspi- combined. By 1921, nearly 30% discuss the merits of hiring a cious of such agreements. of all new Phipps patients came Black nurse to investigate possi- Thus, despite the overall suc- from the Black community. ble cases of TB among its Coal cess of the Phipps Institute in its Tyler, Johnson, and Minton Club and Rainy Day Society early years, the numbers of Black were tireless in their efforts to members.48 During the meeting, patients at the institute remained improve health in the Black com- TB expert and Whittier Centre flat. In contrast with the Phipps munity. They organized health president Landis explained the Institute, the Whittier Centre had lectures in local churches, and advantage of hiring a Black substantive, long-standing rela- the Whittier Centre established a nurse: “to really get behind the tionships with Black residents prenatal clinic, well-baby clinics, scenes requires a visitor within resulting from years of work in and a home supervision service. the race.”49 This nurse would the community, and the board By 1921, the center’s staff of “visit Black families in the home was betting that more Blacks Black clinicians, then known as and subsequently gain their con- would avail themselves of TB the Negro Health Bureau, had fidence” and would more easily care if more Black nursing and grown from one nurse to 10 dispel any fears or superstitions medical staff were available. To graduate nurses and from one individuals held regarding ill- that end, Tyler’s job involved physician to 12.56 However, the ness.50 At this meeting, the Whit- going into the Black community, success of the Whittier Centre’s tier Centre agreed to provide finding residents suspected of health initiatives did not hinge the salary to hire its first Black having TB, and referring them to simply on the introduction of nurse.51 the Phipps clinic for treatment. Black clinicians. The center’s On February 1, 1914, Elizabeth Tyler’s early months at her new accomplishments were the direct Tyler, a graduate of Freedman’s post began with home visits to results of collective efforts under- Hospital Training School in Wash- the nearly 1000 members of the taken by Black community ington, DC, began providing TB Coal Club and Rainy Day Society. members, social reformers, and nursing services to Black residents In a report summarizing the work health professionals that ulti- of south Philadelphia, working of her first year, Tyler noted a mately led to the development under the auspices of the Henry tremendous voluntary response of a collaborative model of com- Phipps Institute; her salary was to her nursing visits and her munity health care many paid for by the Whittier Centre. advice to visit the TB health decades later. The Phipps Institute was a world- clinic. She noted, renowned TB treatment and HEALTH PROMOTION IN it is gratifying to know that the research facility founded in 1903 number of colored people at- BLACK COMMUNITIES by Dr. Lawrence Flick. From its tending the Phipps Institute has TODAY inception, the Phipps Institute been so greatly increased as a direct result of these house-to- offered comprehensive inpatient house investigations.54 Notwithstanding the successes and outpatient treatment of TB.52 of community mobilization and Despite its close proximity to the Her efforts were so effective health initiatives launched by civic Black community, the Phipps that within six months of her associations in the early 20th cen- Institute had not been able to hire, the Phipps Institute hired tury, translating these historic establish a rapport with Black another Black nurse, Cora John- achievements into the context of residents. This may have been son. Later that same year, Minton our 21st-century public health partly caused by its policy requir- (the Black physician who was challenges presents its own set of ing the nearest relative of patients also a member of the Whittier difficulties. Today many urban admitted to the inpatient wards to Centre advisory board) joined the communities are racially and eco- give written permission for an Phipps Institute staff to oversee nomically less diverse than they1398 | Public Health Then and Now | Peer Reviewed | Carthon American Journal of Public Health | August 2011, Vol 101, No. 8
  8. 8. PUBLIC HEALTH THEN AND NOW “used to be, and residents are gen- serve as a valuable way to addresserally less apt to have a mutual the social determinants of health As members of civic associations, Blackssense of shared responsibility among targeted populations. This were more than mere silent partners intoward one another, which limits lesson can be generalized to many need of health and social reform; they werethe spirit of cooperative efforts so different communities throughoutevident among Black club mem- the country, not just racial or eth- crucial to the development of public healthbers a century ago. Still, despite nic minorities. initiatives, and their active participationthe dissimilarities between time Another key strength of the was of paramount importance to the ”periods, we can learn from several civic associations discussed herekey lessons embedded in the his- was their ability to forge social initiatives’ success.tory of civic association commu- bonds between diverse racial andnity health initiatives. class groups. Indeed, the success First, civic associations of the of the health initiatives, particu- of public health initiatives, andearly 20th century, such as the larly the Phipps campaign, hinged their active participation was ofStarr Centre and the Whittier on the ability of civic association paramount importance to theCentre, were in the vanguard of organizers to first build trust initiatives’ success. This focus onmultiple movements, focused among neighborhood residents capacity building, increasingsimultaneously on building a and form relationships with them. social capital, and investing incommunity health infrastructure The introduction of Black clini- developing community leaderswhile also addressing a housing cians aided in this endeavor, but was most notable in the gover-shortage and income deprivation. assigning the success of the Whit- nance and organizational struc-Unlike the disease-focused mod- tier Centre’s anti-TB campaign ture of the Whittier Centre, butels of community health, which merely to the inclusion of racially such a focus can also be seengrew in popularity over the concordant health providers today in community-based partic-remainder of the 20th century, would be a disservice to White ipatory research, which aims tothe associations discussed here philanthropists such as Starr and empower community membersachieved success by identifying Wharton who each spent to own study questions, researchpeople’s material needs first. This decades working among Black methods, and data collected aboutfocus on the comprehensive community residents addressing themselves.58 Like its predeces-wants of the community was community concerns and building sors, community-based participa-based on the recognition that the rapport.57 It was this time com- tory research strives to enhancedeterminants of public health are mitment and active, persistent and increase health awarenessstructural and are largely related engagement with Black club and health activism among mem-to poverty and the environment. members that served as the pre- bers of minority communities.Thus, any effort to address more cursor to Tyler’s work among We now face altogether differ-abstract concerns, such as disease Black Philadelphians. This assem- ent public health concerns fromprevention, first had to address blage of equally invested part- those prevalent a century ago,more immediate needs, such as ners—lay residents, health but health inequities still and coal. Once these areas workers, and philanthropists— Clinicians, researchers, and com-of concerns were addressed, then crossed racial and economic lines. munity health activists can drawinterventions addressing infectious Alhough divergent in origin, they on historical precedents to addressdisease and other maladies fol- remained unified in purpose. contemporary public health con-lowed with a greater degree of A critical strength of the civic cerns by identifying communitysuccess. associations discussed here was strengths, leveraging social net- What history demonstrates in their provision of a platform for works, mobilizing communitythis instance is the importance of community residents to help members, training communitybeginning with an understanding themselves through leadership leaders, and building partnershipsof the base determinants of well- opportunities and cooperative with indigenous communitybeing. A more specific focus on engagement. As members of civic organizations. Many Black andhealth should wait until this pre- associations, Blacks were more minority communities continueliminary step is accomplished. His- than mere silent partners in need to view civic associations, such astory also demonstrates how of health and social reform; they churches and social organizations,building community networks can were crucial to the development as valuable resources for healthAugust 2011, Vol 101, No. 8 | American Journal of Public Health Carthon | Peer Reviewed | Public Health Then and Now | 1399
  9. 9. PUBLIC HEALTH THEN AND NOW information and as places in 2. The poor health of Blacks during the of Pennsylvania Press, 1979), 7–32. early 20th century captured the atten- See also: DuBois, The Philadelphia which to address pressing social tion of a wide range of scholars and Negro, 357; Michael B. Katz, In the concerns. Thus, it is important for public health commentators. See: W.E.B. Shadow of the Poorhouse: A Social His- contemporary public health work- Dubois, “The Health of Negroes,” in The tory of Welfare in America (New York, Philadelphia Negro: A Social Study (Phil- NY: Basic Books, 1986). ers to integrate their health efforts adelphia: University of Pennsylvania 9. “Starr Centre Historical Information within these institutions to Press, 1899), 147–63; C.R. Grandy, Sheet,” p. 2, Starr Centre Collection, advance mutually agreed-upon “The Control of Tuberculosis in the Barbara Bates Center for the Study of Negro,” Virginia Medical Monthly 54 health goals. Civic engagement the History of Nursing, University of (1927): 566–71; C. Guild, “A Five Year Pennsylvania. See also: V.P. Franklin, between community members Study of Tuberculosis among Negroes,” “Operation Street Corner: The Wharton and civic associations is still piv- Journal of Negro Education July (1937): Centre and the Juvenile Gang Problem 548–52; Henry R.M. Landis, A Report otal to the success of community in Philadelphia, 1945–1958,” in W.E.B. of the Tuberculosis Problem and the Negro DuBois, Race and the City: The Philadel- health initiatives. (Philadelphia: Henry Phipps Institute, phia Negro and Its Legacy, ed. Michael 1923), 10a, table 7. Katz and Thomas J. Sugrue (Philadel- 3. Suellen M. Hoy, “‘Municipal House- phia: University of Pennsylvania Press, About the Author keeping’: The Role of Women in Im- 2000), 97; E.J.G. Beardsley, “The Value Margo Brooks Carthon is with the School of the Intelligent Direction of the Sick proving Urban Sanitation Practices, of Nursing, University of Pennsylvania, Poor - A Story of The Starr Centre As- 1880–1917,” in Population and Reform Philadelphia. sociation of Philadelphia,” Therapeutic in American Cities, 1870–1930, ed. Correspondence should be sent to Gazette June (1911): 2. M.V. Melosi (Austin: University of Texas Margo Brooks Carthon, 418 Curie Blvd, Press, 1980), 173–98. 10. Beardsley, “The Value of the Intelli- Philadelphia, PA 19104-6096 (e-mail: Reprints 4. Susan L. Smith, Sick and Tired of gent Direction of the Sick Poor,” 2; can be ordered at by Being Sick and Tired: Black Women’s “Starr Centre Historical Information clicking the “Reprints/Eprints” link. Health Activism in America, 1890–1950 Sheet,” Starr Centre Collection, p. 2. This article was accepted January 10, (Philadelphia: University of Pennsylva- 11. Starr Centre Association, “Charter 2011. nia Press, 1995), 32. See also: Darlene and Bylaws of the Starr Centre Associa- Clark Hine and Kathleen Thompson, A tion,” June 2, 1905, p. 4, Starr Centre Shining Thread of Hope: The History of Collection, box 9, folder 105. Acknowledgments Black Women in America (New York: 12. Beardsley, “The Value of the Intelli- Margo Brooks Carthon is supported by Broadway Books, 1998). gent Direction of the Sick Poor, ” 1–11. the National Institute for Nursing Re- 5. The formation of Black churches and search (grant K01NR012006). This re- 13. Starr Centre, “A Few Facts About other social and benevolent societies search was also supported by a Ruth L. the Starr Centre,” 1905, Starr Centre represented an important antidote to Kirschstein NRSA Doctoral Fellowship Collection, MC 9, series IV, folder 105; anti-Black sentiment, social isolation, from the Agency for Healthcare Re- Starr Centre Association, “Milk and and prejudice. Philadelphia’s Free Afri- search and Quality (grant F-31 Medical Department,” 1911, Starr Cen- can Society, established in 1787 by HS01029-02). tre Collection, MC 9, series IV, folder Richard Allen and Absolam Jones, is an Special thanks to Julie Fairman, PhD, 104. example of such an organization. For Joan Lynaugh, PhD, Barbara Savage, further reading on benevolent societies, 14. Starr Centre Association, untitled PhD, Robin Stevens, PhD, Bridgette see Hine and Thompson, A Shining pamphlet, 1907, Starr Centre Collec- Brawner, PhD, Jillian Baker, PhD, Jasmine Thread of Hope, 39. tion, box 9, folder 105. McDonald, PhD, and Melissa Gomes, PhD, 6. US Bureau of the Census, Negro Pop- 15. Susan P. Wharton, “Starr Centre for their support and feedback on ear- ulation in the United States, 1790–1915 First Annual Report,” 1903, Starr Cen- lier drafts of this article. (Washington, DC: Government Printing tre Collection. Office, 1968), 350–51; Allen F. Davis, 16. Starr Centre Association, untitled The Peoples of Philadelphia: A History of pamphlet, 1907, Starr Centre Collec- Endnotes Ethnic Groups and Lower Class Life, tion, box 9, folder 105. 1. The enduring pattern of health ineq- 1790–1940 (Philadelphia: Temple Uni- uities among Black communities has 17. Starr Centre Association, board of versity Press, 1973). For more on the been captured in the work of a number directors meeting minutes, July 13, migration patterns of Blacks entering of historians from the 19th and early 1911, Starr Centre Collection. Philadelphia, see: Armstrong Associa- 20th centuries. For more on the history tion, “Report of Negro Population and 18. It is important to note that intrara- of illness among Blacks, see: David Industries in Philadelphia,” 1927, mim- cial tensions were not uncommon McBride, From TB to AIDS: Epidemics eograph, Armstrong Association Papers, among Black civic association members among Urban Blacks Since 1900 (New Urban Archives, Temple University Li- because of differences in class standing York: University of New York Press, braries. and religious affiliation. In her historical 1989); Keith Wailoo, Dying While in the account of health promotion in the rural City (Chapel Hill: University of North 7. Sadie T. Mossell, “The Standard of south, historian Susan Smith uncovers Carolina Press, 2001); Vanessa Gamble, Living among One Hundred Negro Mi- evidence of such tensions in her exami- Germs Have No Color Lines: Blacks and grant Families in Philadelphia,” Annals nation of the Tuskegee Woman’s Club. American Medicine 1900–1940 (New of the American Academy of Political and The club women were all Black, edu- York: Garland Publishing, 1989); Sam- Social Science 98 (1921): 174–75. cated, and well off, and they believed it uel Kelton Roberts Jr, Infectious Fear: 8. Franklin VP. The Education of Black their “calling” to improve the physical, Politics, Disease, and the Health Effects of Philadelphia: The Social and Educational spiritual, moral, and educational lives of Segregation (Chapel Hill: University of History of a Minority Community, rural Blacks. Middle-class Black women North Carolina Press, 2001). 1900–1950 (Philadelphia: University asserted that their class, as well as their1400 | Public Health Then and Now | Peer Reviewed | Carthon American Journal of Public Health | August 2011, Vol 101, No. 8
  10. 10. PUBLIC HEALTH THEN AND NOWgender, made them uniquely fit to bring 35. It remains a mystery why, after so the Whittier Centre. Whittier Centre, 1926; “Dedication of the Phipps Insti-about the salvation of the race. These many years of work with the Black “Annual Report,” 1915, p. 4, Wharton tute,” news clipping, December 1909.assumptions often led to tension be- community, the Starr Centre Associa- Center Collection. All items in Information Files Collection,tween middle-class and poor club mem- tion jettisoned those relationships and 41. Whittier Centre, “Annual Report,” UPF 8.51, University of Pennsylvaniabers. See: Smith, Sick and Tired of Being handed them to Wharton. I suspect that 1917, pp. 7–8, Wharton Center Collec- Archives. See also: Bates, Bargaining forSick and Tired, 18–21. the needs of the community were out- tion. Life. pacing the Starr Centre’s capacity. Also, 53. Bates, Bargaining for Life, 108.19. Susan P. Wharton, “Negro Branch of 42. Henry R.M. Landis, Whittier Centre, the Black community’s growth was sothe Starr Centre,” 1909, Starr Centre “Annual Report,” 1916, p. 2, Wharton 54. Whittier Centre, “Annual Report,” tremendous that the Starr Centre mayCollection. Center Collection. 1915, pp. 4–5, Housing Association of have been increasingly regarded as an20. Starr Centre Association, “Annual “organization for Blacks,” which might 43. First annual message of John Rey- the Delaware Valley (HADV) Collection,Report,” 1911, p. 7, Starr Centre Collec- have reduced its viability for other burn, 1908, p. 96, City Archives, Phila- Urban Archives, Temple University Li-tion. needy sections of the community. These delphia. braries.21. Starr Centre Association, board of thoughts, however, are purely conjec- 55. Whittier Centre, “Annual Report,” 44. Bureau of Health, “Annual Report,”directors meeting minutes, July 13, ture; the historical record is silent about 1916, p. 2, HADV Collection. 1918, City Archives, Philadelphia.1911, Starr Centre Collection. the real motives behind the center’s re- 45. Mossell, A Study of the Negro Tuber- 56. Whittier Centre, “Annual Report,” sistance to expansion of services tar-22. Starr Centre Association, “Annual culosis Problem in Philadelphia, 18. 1924, p. 13, HADV Collection. It is geted toward Blacks.Report,” 1911, p. 10, Starr Centre Col- worth noting that the local health inter- 36. Whittier Centre, “Annual Report,” 46. Barbara Bates, “P.S. I Am . . . Col-lection. ventions of the Whittier Centre and the 1914, Wharton Center Collection. One ored,” in Bargaining for Life: A Social Phipps Institute were not isolated initia-23. Wharton, “Negro Branch of the History of Tuberculosis, 1876–1938 of the Whittier Centre’s earliest collabo- tives to improve health in Black com-Starr Centre,” p. 16, Starr Centre Collec- (Philadelphia: University of Pennsylva- rations was with the Philadelphia Hous- munities; they in fact ran parallel to na-tion. nia Press, 1992), 288–310. ing Commission, a privately funded as- tional efforts such as National Negro24. Sadie T. Mossell, “A Study of the sociation working toward housing 47. Landis, A Report of the Tuberculosis Health Week, which Booker T. Wash-Negro Tuberculosis Problem in Philadel- reform. In 1914 the commission con- Problem and the Negro, 1. See also: ington launched in 1915 to increasephia,” 1923, p. 18, Starr Centre Collec- ducted a study on the housing condi- Henry Phipps Institute, “Fifth Annual health awareness among Blacks.tion. tions of the city’s Black residents, and Report,” 1909, pp. 10, 19, Philadelphia 57. The Starr Centre and Whittier Cen-25. Whittier Centre, “Annual Report,” the Whittier Centre offered the services College of Physicians. In his annual re- tre represent just two examples of inter-1917, p. 7, Wharton Center Collection, of its visiting staff to collect data for the port to the Phipps Institute, Lawrence racial cooperatives run collaborativelyURB 30, series I, box 1, Urban Ar- study. Data collectors visited 1158 Flick, head of the institute’s Clinical and by Blacks and Whites. Other historicalchives, Temple University Libraries. homes, where 4891 Blacks lived. The Sociological Departments, noted the low examples reveal the importance of results of this study were published in percentage of Blacks treated at the insti-26. Wharton, “Negro Branch of the building trust and improving communi- the Whittier Centre’s “Annual Report” tute since its inception. Blacks repre-Starr Centre,” 1909, p. 4, Starr Centre cation across race and class lines to ad- (1914) and summarized by Bernard J. sented 6.63% of the total percentage ofCollection. dress health and social inequities. In Newman, executive secretary of the Phipps patients during its first year Chicago, for instance, White settlement27. Ibid. Philadelphia Housing Commission. (1904), 5.65% in 1905, 5.96% in workers joined Black reformers in 1906, 9.83% in 1907, and 7.68% in28. Ibid. 37. Henry R.M. Landis was a key figure founding the Frederick Douglass Center, 1908. He further reported that Blacks during the Phipps Institute’s first three an interracial settlement that cam-29. Starr Centre Association, “Annual held nearly the highest rates of single decades of operation. Born in 1872, paigned for equal treatment for Blacks.Report,” 1911, p. 7, Starr Centre Collec- visits with no return follow-up, com- Landis was a leading clinician and re- For further reading on interracial coali-tion. pared with other racial/ethnic groups. searcher in the field of TB and was per- tions in Chicago, see: Steven J. Diner,30. Starr Centre Association, “Annual Lawrence Flick, “Clinical and Sociologi- sonally chosen by renowned TB special- “Chicago Social Workers and Blacks inReport,” 1909, pp. 4–5, Starr Centre cal Report,” 1909, Phipps Institute Re- ist Lawrence Flick to work at the the Progressive Era,” Social Service Re-Collection. ports, Van Pelt Library, University of institute. After graduating with an AB view 44, no. 4 (1970): 393–410. Inter- Pennsylvania.31. Ibid. from Amherst College in 1894 and racial cooperation also emerged through completing medical school at Jefferson 48. Whittier Centre, executive board evangelical and religious efforts, such as32. For further reading on interracial Medical College in Philadelphia in meeting minutes, 1913, p. 1, Wharton the Young Women’s Christian Associa-and class tensions, see: Gerda Lerner, 1897, Landis embarked upon a career Center Collection. tion (YWCA). The YWCA experienced“Early Community Work of Black Club specializing in the treatment of TB. both interracial discord and coopera-Women,” Journal of Negro History 59, 49. Ibid. Landis was renowned both nationally tion, but it remains an illustrative exam-no. 2 (1974): 158–97. and locally, serving as the founder of 50. Ibid. ple of the triumphs and complexities of33. Starr Centre Association, board of the National Tuberculosis Association and 51. Tyler’s work as a public health building community networks. For fur-directors meeting minutes, May 28, presiding over the Pennsylvania Tuber- nurse is consistent with the efforts of ther readings on the history of the1912, p. 1, Starr Centre Collection. culosis Society from 1928 to 1932. her peers in the profession during this YWCA, see: Nancy Marie Robertson,Wharton’s full plan for expanding ser- While at Phipps he functioned as an as- period. For further reading on Black “Kindness or Justice? Women’s Associa-vices for Black club members included sistant professor of medicine and direc- public health nurses, see: Marie O. Pitts tions and the Politics of Race and His-the establishment of a separate neigh- tor of the Clinical and Sociological De- Mosely, “Satisfied to Carry the Bag: tory,” in Private Action and the Publicborhood house for Blacks, with the ad- partments, and he served as visiting Three Black Community Health Nurses; Good, ed. Walter W. Powell and Elisabethdition of a head social worker to coordi- physician to the Commonwealth of Contributions to Health Care Reform, Stephanie Clemens (New Haven, CT:nate services. The board considered Pennsylvania’s White Haven Sanato- 1900–1937,” Nursing History Review 4 Yale University Press, 1998), 193–96.whether it would continue its work with rium. He was also connected clinically (1996): 65–82. Also, on Black hospital 58. Nina Wallerstein and Bonnie Duran,Blacks should Wharton depart; they de- with Philadelphia General Hospital until nurses, see: Darlene Clark Hines, Black “Community-Based Participatory Re-cided instead to allow Wharton to as- 1909. Women In White: Racial Conflict and search Contributions to Intervention Re-sume responsibility for all services pro- Cooperation in the Nursing Profession, search: The Intersection of Science and 38. Whittier Centre, “Annual Report,”vided to the Starr Centre’s Black club 1890–1950 (Bloomington: Indiana Uni- Practice to Improve Health Equity,” 1914, Wharton Center Collection.members. versity Press, 1989). American Journal of Public Health 100, 39. Ibid. no. S1 (2010): S40–S46.34. Starr Centre Association, board of 52. Lawrence Flick, “Report of thedirectors meeting minutes, June 11, 40. By 1914, half of the former respon- Henry Phipps Institute,” 1904, pp. 4–5;1912, p. 2, Starr Centre Collection. sibilities of the Starr Centre rested with “The Phipps Gift,” Gazette, March 5,August 2011, Vol 101, No. 8 | American Journal of Public Health Carthon | Peer Reviewed | Public Health Then and Now | 1401
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