Elman Cheryl, Feltey Kathryn M, Wittman Barbara, Stevens Corey, Hartsough Molly B
Social Science Research Institute, Duke University and Department of Sociology, The University of Akron, Akron, OH, USA.
Department of Sociology, The University of Akron, Akron, OH, USA.
Du Bois Rev. 2025 Spring;22(1):93-117. doi: 10.1017/s1742058x24000092. Epub 2024 Oct 31.
The twenty-first century COVID-19 epidemic revealed a U.S. public health system that countenanced health inequities and a U.S. public that resisted disease containment policies. This crisis, however, was only the most recent chapter in a longer struggle in the United States to institutionalize public health. We focus on two early twentieth-century public health campaigns in the American South, the unhealthiest U.S. region at the time. Black southerners-denied basic health, political, economic, and social rights under a rising Jim Crow regime-self-organized health services networks, including through the Tuskegee Woman's Club, the Negro Organization Society of Virginia, and the Moveable School (1890s-1915). Around the same time, a philanthropic project, the Rockefeller Sanitary Commission (RSC, 1909-1914), seeded state-level public health agencies in eleven southern states, thereby installing public health in a top-down manner. We use archival data sources to explore key similarities and differences in the public health concerns and coalition-building approaches of each campaign and southern resistance to their efforts. We find Black-led campaigns often blurred the color line to form coalitions that provided services to the underserved while tackling environmental health risks at the community level. In contrast, RSC affiliates in southern states, as directed by RSC administrators, provided health services as short-term public dispensaries. Services reached Black and White communities willing to participate but in a manner that did not overtly challenge Jim Crow-era practices. Southern resistance to public health expansion persisted under each approach. The legacies of these struggles remain; the political-economic and ideological forces that limited public health expansion while marginalizing Black community health efforts reverberate in public health inequities today.
21世纪的新冠疫情暴露出美国公共卫生系统对健康不平等现象的容忍，以及美国公众对疾病防控政策的抵制。然而，这场危机只是美国在将公共卫生制度化的漫长斗争中最近的一章。我们关注美国南方在20世纪初开展的两项公共卫生运动，当时南方是美国最不健康的地区。在日益兴起的吉姆·克劳种族隔离制度下，南方黑人被剥夺了基本的健康、政治、经济和社会权利，他们自行组织了卫生服务网络，包括通过塔斯基吉妇女俱乐部、弗吉尼亚黑人组织协会和流动学校（19世纪90年代至1915年）。大约在同一时期，一个慈善项目——洛克菲勒卫生委员会（1909年至1914年）在南方的11个州建立了州级公共卫生机构，从而以自上而下的方式推行公共卫生。我们利用档案数据源来探究每项运动在公共卫生关注点和联盟建设方法上的关键异同，以及南方对这些努力的抵制。我们发现，由黑人领导的运动往往模糊了肤色界限，形成联盟，为服务不足的人群提供服务，同时在社区层面应对环境健康风险。相比之下，南方各州的洛克菲勒卫生委员会附属机构按照委员会管理人员的指示，作为短期公共诊疗所提供卫生服务。服务覆盖了愿意参与的黑人和白人社区，但方式并未公然挑战吉姆·克劳时代的做法。在每种方式下，南方对公共卫生扩张的抵制都持续存在。这些斗争的遗产依然存在；那些限制公共卫生扩张同时将黑人社区卫生努力边缘化的政治经济和意识形态力量，如今在公共卫生不平等现象中仍有回响。
