By Christine Ardalan, author of The Public Health Nurses of Jim Crow Florida
News reports during the spring and summer months of 2020 documenting the outbreaks and deaths caused by the COVID-19 pandemic shined a spotlight on the disproportionate occurrences in Black communities. Black Americans were not only more likely to be infected with the coronavirus but also more likely to die from the disease. Unable to overcome years and years of poor access to healthcare, Black communities faced a crisis that points a finger at racism—racism that permeates our everyday lives with the power and the pervasiveness to breed racialized health disparities. Change is long overdue. Leaders in public health call for it and leaders of the Black Lives Matter movement demand it. The rebellion to right the inequities of health care disparities—to reach those left out of modern medical practice—has been long in the making. Let us look back to see just how long by considering the work of Florida’s public health nurses during the Jim Crow era.
Black lives mattered to these public health nurses who were challenged to find ways to serve the underprivileged to prevent illness and disease or improve childbirth and general well-being. In the early twentieth century, these mostly white and a few Black pioneering professional women began the work to tackle the state’s health issues born of race and poverty. They faced an uphill task considering the stark differential between white and Black infant mortality rates, tuberculosis rates, and other disease rates. These nurses saw it as their responsibility to demand people shake off their indifference to progress in health work and cooperate interracially to bring about better health conditions in the state. They traveled the state demonstrating the home treatment for tuberculosis and teaching about sanitation. They reached out to midwives to reduce stillbirths and maternal deaths. And they forged paths to counter the neglect of children’s health as Black children were especially left out. To be sure, they met roadblocks that indicated Jim Crow’s iron grip on all aspects of Southern life. One nurse complained that physicians did not cooperate with her to seek out Black tuberculosis patients and did not “feel like bothering with them in any way.” She bemoaned, “If they would only keep [the patients’] addresses and names, so I could find them.”[i] Often these nurses were the only ones available to exert influence that would literally save people’s lives, but negotiating their way to serve all regardless of race was complicated by the state’s deep-rooted cultural challenges.
The cultural construction of race stands out in Florida’s public health policies, which were inseparable from racist ideology. In the first decades of the twentieth century, Florida’s state health officials justified reaching out to the Black population by arguing that this group was the cause of disease. “The undue morbidity of the State of Florida is chargeable in large part to the ignorance and lack of right living of the part of the negro population,”[ii] stated public health evaluator Carroll Fox in 1915. He reasoned that Black lives did indeed matter for two reasons: “not only to prevent the spread of disease to the white population, but also to conserve the life and health of the laboring classes of the South, upon whose physical fitness many industries depend.” Black leaders, however, saw a different joint mission: health work was both a way to promote wellbeing in all populations and an opportunity to cooperate, “one of the most effective methods of bringing two races together on a platform of mutual confidence and respect with a mutual desire to help.”[iii] But cooperation was a hard sell to Florida’s counties. For example, in 1925—even though the latest statistics revealed African American deaths from tuberculosis were far in excess of white deaths—only ten of the sixty-seven counties observed National Negro Health Week. Public health nurses therefore could only make inroads “to stimulate health work among colored people” in the ten counties that observed the life-saving program.
During the 1920s, public health nurses hoped their robust work to implement the Sheppard-Towner Maternity and Infancy program would reduce the stark disparities in Black and white infant and maternal mortality deaths. Yet saving lives and improving midwives’ practices clearly did not matter to the State Board of Health members and neither did the career path of a professional Black nurse. In 1926, public health nurse director Laurie Jean Reid reported the forced resignation of the lone Black state health nurse, who had been an important conduit to connect the maternal and infant policies with the African American communities. Reid complained, “It has been difficult to explain the reason for a colored nurse on the staff to the satisfaction of the old conservative southerners in the state and it was finally decided to be the fixed policy of the State Board of Health not to employ Negro nurses.”[iv] This policy was a blow to the nursing program and a reflection of how cultural mores informed Black and white nurses’ practices differently. Black nurses required a double dose of resolve to address prejudice both in their practice as well as within the national nursing profession itself. It would be another ten years before another Black nurse, Ethel Kirkland, was employed by the State Board of Health as the Midwife Teacher. Though she and those who came before her and after her during the Jim Crow era were slighted professionally. State reports formalized the exclusion of Black nurses from the courtesy of the formal titles “Miss” or “Mrs.” This was a policy that extended nationally to the white press and to the bitter path of exclusion by the American Nurses Association, underscoring the double-edged sword of Jim Crow inequities for Black nurses.
During this era, whether Black or white, nurses navigated the cultural mores of the state to do the good work of saving lives in Florida—and often they were the only ones who could. In their mission to right the inequities of health care disparities, they became bridges to connect with people physically—and just as importantly, mentally—by forming relationships to correct misunderstandings, allay fears, conduct community meetings, hold clinics, and more. It is the legacy of their interpersonal connections and the interplay between these nurses and those they sought to serve that suggests their work could add to today’s conversation of connecting health policy with social action. If we consider the revelations brought to public attention by COVID-19 as a reflection of systemic racism and the climax of more than a century of struggle to provide care to vulnerable population groups, can a glimpse of the historical context in Florida help to make today’s voices for change louder and stronger? Can we change some of the ways we connect and support each other to address and improve the disparities in today’s healthcare matters? It is surely our responsibility.
Christine Ardalan, lecturer of history at Florida International University, is the author of The Public Health Nurses of Jim Crow Florida.
[i] Jessie Wheeler, State Board of Health of Florida, Twenty-Eighth Annual Report, 1916, 155; In Christine Ardalan, The Public Health Nurses of Jim Crow Florida,( Gainesville: University Press of Florida), 46.
[ii] Carroll Fox, “ Public Health Administration in Florida,” Public Health Reports 31, no. 22 (1916): 1385; In Ardalan, The Public Health Nurses of Jim Crow, 18.
[iii] Robert Russa Moton cited in Susan L. Smith, Sick and Tired of Being Sick and Tired, Black Women’s Health Activism in America 1890-1950(Philadelphia: University of Pennsylvania Press, 1995), 36; In Ardalan, The Public Health Nurses of Jim Crow, 69.
[iv] Laurie Jean Reid, “Report to Grace Abbott,” May 1926, file 11-11-8 , box 325, RG 102 Children’s Bureau Central File, 1925-1928, NARA; In Ardalan, The Public Health Nurses of Jim Crow, 72.
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