Progressive Public Health Administration in the Jim Crow South: A Case Study of Richmond, Virginia, 1907-1920
Hoffman, Steven J., Journal of Social History
During the first decades of the twentieth century, various Southern cities began to employ new public health techniques in the administration of their public health departments. These techniques not only included introducing new scientific advances in epidemiology, diagnostics, and disease control, but also involved incorporating various social programs within the health department, most notably those associated with public health nursing. Although much has been written about the public health advances of this period from a northern, or national perspective, only a few studies have examined early twentieth century urban public health in its southern context.  Fewer still are the studies that specifically examine the interplay of race and public health.  By exploring the role of race in the development of three campaigns conducted by the Richmond Department of Public Health--the campaigns against typhoid fever, infantile diarrhea, and tuberculosis--this study will show that African Americans received few of the benefits derived from Richmond's move toward improved public health, and that the benefits they did receive were confined to those programs administered by the city's public health nurses. The pattern of racial differentials amid southern public health advance is an important story in its own right, if unsurprising given the racial attitudes of the time. The rare exceptions to this pattern also deserve exploration, yet the overall result formed a stark context for African-American life in Richmond.
In the early twentieth century, when Richmond, Virginia embarked on its campaign to modernize its public health department, national standards of public health practice were being developed in the North.  Confounding the easy importation of northern ideas of public health directly into southern practice, however, was the fact that the urban population of African Americans, a group that routinely experienced high rates of mortality and morbidity, was relatively high, and American racism existed in a very specific and institutionalized fashion. One of the consequences of southern racial attitudes was that, in Richmond and other southern cities, African Americans did not constitute a primary constituency for public health intervention.  This was based, in part, on strongly held beliefs that African Americans were largely responsible for creating their own particular health problems, either as the result of behavior or inheritance.  As a result, improvements in black health were largely incidental to eff orts to make southern cities healthier for their white citizens. With few exceptions, all of Richmond's public health initiatives tended to be undertaken with little regard for the particular health problems of the city's black population. Only in those programs administered by the city's public health nurses did African Americans receive health care services in proportion to their needs. The advent of city programs administered by public health nurses in Richmond held great Promise for improving the health of the city's African Americans, but in the end, they only achieved limited and short-term success. As this study shows, because of the racial discrimination inherent in the system of healthcare delivery, public health nursing's potential to dramatically improve the health of the city's blacks was never fully realized and Richmond's African-American community benefited only marginally from the city's overall advancement in public health.
In Richmond, as elsewhere, advances in public health were often closely tied to economic and political developments in the city.  At the turn of the century, Richmond was a growing and economically diverse city with a large African-American population. Between 1890 and 1920 Richmond's population more than doubled from 81,388 to 177,667. Although their percentage of the total population steadily declined during these years, African Americans remained an integral part of the city's workforce as the African-American population increased from 32,330 to 54,041 (see Table 1). …