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• 1 media/cropped i182702_pm.jpg media/i182702_pm.jpg 2022-12-14T00:06:55+00:00 Black Public Health Nurses in History 31 image_header 2023-01-11T20:58:15+00:00 Above: African American visiting nurse at an appointment with a family, including young children, 1956, Chicago, Illinois
  
  Public health nursing has historically been one of the best options open to Black nurses when few other opportunities existed. Public health nurses travel into communities to prevent illness, provide health and wellness education, and care for people of all kinds, especially those populations who do not have easy access to doctors or hospitals. Public health nurses also often do the difficult work of addressing social and structural barriers to health, rather than focusing narrowly on treating each patient as is customary in a hospital or clinic. Even in the early 1900’s when almost all white-run hospitals refused to hire Black nurses, many white healthcare leaders understood the value that Black nurses brought to the public health field. For many decades, Black public health nurses still faced discrimination; they rarely received promotions and were usually restricted to treating only Black patients. Yet since the early 1900’s until today, Black nurses have often served as the most important healthcare presence in many Black communities, acting as social workers, educators, and nurses, in whatever role the community has needed.  
  
  In the early 1900’s, public health work often represented a good opportunity for Black nurses. Black nurses also earned more in public health than in any other field. Public health jobs allowed them to work out in the community, where they had more autonomy and faced less racial prejudice than they did in hospitals or in private homes.1
  
  Early archival sources show that public health work varied dramatically between the North and the South.
  
  PUBLIC HEALTH NURSING IN THE NORTH
  Ethel Johns, a white British-Canadian nurse, traveled across the United States in 1925 to prepare a report on Black nursing and health for the Rockefeller Foundation. Johns noted that municipal boards of health in Northern cities hired Black nurses because they legally could not exclude them if they had the necessary qualifications and passed the civil service exam. Yet many white supervisors spoke negatively about the Black nurses working for them, claiming that they were less skilled and caused problems. These “problems” were often the result of white communities objecting to visits from Black nurses. One official at the Chicago City Health Department complained that Black nurses tended to “organize against authority.”2 This language seems to indicate that white supervisors criticized Black nurses for speaking up to advocate for themselves or their communities.
  
  Meanwhile, private social service agencies (known as visiting nurses services) in northern cities were not required to hire Black nurses, but they chose to because they wanted them to work in Black communities. The Chicago Visiting Nurses Association hired many Black nurses over the course of its existence, including Carrie Bullock (see breakout box), a leader in public health nursing and in the National Association for Colored Graduate Nurses.
  
  
  
  In both public and private agencies, Black nurses were almost never promoted to supervisor positions, because white nurses refused to be supervised by them. They also generally were only allowed to serve Black communities, which was often a waste of resources, as Black nurses spent extensive in transit between different Black areas. However, in northern cities Black public health nurses usually earned the same salary as white nurses in the same position, making this appealing work at a time when Black nurses had few other employment options. Northern cities hired increasing numbers of Black nurses as Black people moved from the South to these cities during the Great Migration. In Chicago in 1930, 7.5% of public health nurses were Black, while Black people made up 4.1% of the city’s population.3
  
  PUBLIC HEALTH NURSING IN THE SOUTH
  The situation in the South was more difficult. Black nurses who were born or trained in the North usually refused to work in the South. Boards of Health were sometimes more motivated to hire Black nurses than in the North, because Southern white nurses were more likely to refuse to travel to Black communities. However, Black nurses in the South were paid substantially less than white nurses. Black nurses also had to deal with a racist Southern culture in which nursing work was deeply tied to slavery and the image of the “Mammy” caring for people on the plantation. Black teachers and social workers often received better treatment than nurses. 
  
  Access to nursing and public health training also caused problems for Black nurses, especially in the South. Black nurses suffered from the inequalities in public education, which made them less prepared for nursing school. Yet even if they earned a nursing diploma, Black Southern nurses had very few opportunities for additional postgraduate training in public health. Public health officials claimed that they wanted to hire Black public health nurses but could not find any qualified candidates.
  Meanwhile white-run hospitals and school refused to accept Black nurses, and most Black hospitals with the resources to offer public health courses were in the North. Historical reports show that Black nurses often tried to get training in whatever way they could, either at Black hospitals (like Provident) or through informal opportunities to observe public health work in different settings. Yet Black nurses also wondered if it was worth the trouble, given that they knew, even with specialized training, they were unlikely to advance in their careers.4 
  
  Black leader Estelle Massey Osborne wrote about this hypocrisy in the 1930s, highlighting that there were more Black nurses than public health jobs in the North, while most Black people still lived in the South. In 1937, Osborne estimated that the ratio of Black public health nurses to Black Americans was 24,000 people to 1 nurse.5
  
  BLACK PUBLIC HEALTH NURSES: SKILLS & IMPACT 
  Public health nurses in Black communities provided critical healthcare access. In the early twentieth century, Black Americans increasingly died from preventable and curable diseases like tuberculosis and typhoid. In northern and southern cities, they lived in crowded, segregated communities with few job opportunities. In the South they often lived in remote rural communities. All over the country, they suffered from a lack of access to healthcare.
  
  The white doctors and nurses who they did encounter were often racist, leading them to distrust any possible care or education they received.
  One story of a Black patient who was brought to a hospital in Charlotte, North Carolina in the early 1900’s is a good example of this mistrust:

  “The next patient, protesting and struggling violently, was brought in by two policemen. His physician had advised his coming, his family approved, but he had heard rumors that people were carved up with butcher knives in hospitals, so he rebelled.”6

  
  Black public health nurses often served as the sole trusted healthcare presence in many of these communities. They entered Black homes and schools, building connections with members of the community. They taught nutrition and hygiene, vaccinated schoolchildren, and visited expecting mothers in their homes.
  
  In 1937, the National Tuberculosis Association stated that:

  “[T]he Negro [sic] public health nurse is by far the most effective agent in giving information on health to the Negro [sic] group. She gets into the home, makes contacts with every member of the family, and shows them rather than tells them what to do for better health. She has demonstrated her ability to work more effectively among her own people than the white nurse, and this despite the all too frequent handicap of poor undergraduate training and no public health training other than that received ‘on the job’”.7

  
  Public health organizations like the National Organization for Public Health Nursing (NOPHN) had a history of more inclusive racial politics than other nursing institutions like the American Nurses Association. The NOPHN was a key ally for the National Association for Colored Graduate Nurses in their fight to integrate military nursing during WWII. This was likely in part because public health organizations saw firsthand the value of Black nurses’ work.
  
  This work required far more than knowledge about medicine; it required the patience and interpersonal skills to build real relationships. Eunice Rivers, a Black public health nurse working in rural Georgia in the 1930’s, described her approach during her home visits:

  “[T]hey’re people as far as I’m concerned. I don’t go there dogging them about keeping the house clean. I go there and visit a while until I know when to make some suggestions. When I go to the house, I accept the house as I find it. I bide my time…continued, “Sometimes I don’t do a thing but go there, sit down there and talk.8

  
  
  Black public health nurses were also important for how they brought attention to the wider issues that impacted community health. Jessie Sleet Scales (see breakout box), possibly the first Black public health nurse in New York City, worked for Tuberculosis Committee of the Charity Organization Society (a private social services agency) between 1900-1909. Sleet Scales visited Black homes to treat sick patients, but she also wrote extensive reports arguing that housing and employment discrimination had a direct impact on Black people’s health.9 Since Scales’ time until today, Black public health nurses have served in underserved communities, built relationships, and worked to address structural healthcare problems and inequalities.