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Health Work For Negro Children
Forrester B. Washington, Executive Secretary, Armstrong Association, Philadelphia, Pennsylvania
A Presentation in the “Proceedings Of The National Conference Of Social Work” (Formerly National Conference of Charities and Correction) At The Fifty-Second Annual Session Held In Denver, Colorado June 10-17, 1925
There are too many deaths among Negro children today, for the good of the Negro race and for the good of the country as a whole. The Negro race needs a stronger and more healthy younger generation to help it combat successfully the many obstacles which it must meet. In addition to the normal struggle for existence, the black man in America must endure a number of handicaps. He must make his living by means of the lowest-paid and most unhealthful jobs in industry, though this condition is improving somewhat in certain sections of the country. He must struggle for life itself against unfavorable environments in the form of the least healthful neighborhoods and the oldest and most unsanitary houses.
The nation itself needs a stronger and more healthy younger generation of negroes, because more and more it is coming to depend upon Negro labor for the unskilled processes in its industries, particularly in its most basic industries, such as the fabrication of iron and steel, coal mining, ship building, meat packing, the manufacturing of automobiles, and the like. Indications point to the fact that in the not far distant future, especially if the restriction of foreign immigration continues, it will have to depend almost entirely upon Negroes for the unskilled processes, and, to a much larger extent than at present, for the semiskilled and skilled processes of industry.
What are the conditions of mortality among Negro children today? I will have to use figures for infant mortality largely because very few cities could give me death-rates for child age groups over one year, nor could they give me the distribution of their Negro and white populations according to age groups in order that I might estimate for myself the mortality rates for children in the various age groups over one year. However, experience has shown that the infant mortality rate is a fair index of health conditions among children in general.
According to the United States mortality statistics for the birth registration area for I922, the per thousand deaths for the birth registration area was 76; the infant mortality rate among the white infants was 73, and among the colored infants was iio. The infant mortality rate in the total cities in the registration area in I922 was 80; among the colored babies it was 127. It is obvious, then, that in the two divisions the mortality rate among colored infants was from 50 per cent to 70 per cent higher than among whites.
Let us consider conditions in certain representative cities, taking them not arbitrarily, but selecting them in the order of the size of their Negro population. New York City has the largest Negro population in the country. Its Negro infant mortality rate is more than twice that of the general population of the city. Philadelphia, with the second largest Negro population in the country, had an infant mortality rate for Negroes of 135 in I922, while that for white babies was only 79.
Regarding Washington, the city with the next largest population, I have some interesting figures for age groups other than those of infants. These rates are for last year (I924). The death-rate for colored children of one to five years in that city was 79, while that of whites was only 31. The death-rate for colored children of five to nine years was 26, while that for White children was I7. Apparently, colored children up to nine years of age die twice as fast as white children of the same age in Washington.
In Baltimore, which has the fifth largest Negro population, the death-rates for the various age groups for 1924, for both races, were as follows: the infant mortality for Negroes was I9I.05; for whites, 78.04. The death-rate from one year to four years for Negroes was 19.42; for whites, 7.27. The death-rate for Negroes from five to nine years was 3.59; for whites, 2.34; and the death-rate for Negroes from ten to fourteen years was 4.00; for whites, 1.74. For Birmingham, Alabama, having the seventh largest Negro population, the infant mortality rate for Negroes was 130.4; for whites, 68.8.
Regarding conditions in St. Louis, which is next in standing according to the size of Negro population, let me quote from an article published in April, 1925, in The Nation’s Health, by Dr. Park J. White of the St. Louis Children’s Hospital. Dr. White says: “In St. Louis the infant mortality rate, the stillborn rate, the foundling mortality rate, the incidence of rickets, of rickets plus malnutrition, of hereditary syphilis, and of tuberculosis are all three times higher for colored babies than for whites. Thus, the colored baby in St. Louis has half the white baby’s chance for survival, and from two to three times the white baby’s chance for contracting the (largely preventable) diseases mentioned.”
Other cities having large Negro populations from which I was able to obtain information were Mobile, which in I924 had a Negro infant mortality rate of 97, and a white infant mortality rate of 56; Detroit, Michigan, which in 1924 had an infant mortality rate for Negroes of 119, and 76 for whites; Columbus, Ohio, which showed a rate of 97 for Negro infants and 56 for whites; Kansas City, Missouri, with a Negro population of 30,706 in 1920, which had a Negro infant mortality rate in 1924 of 155.3, and a white rate of 78.
Lynchburg, Virginia, gave the following figures for child death-rates in I924: Negro infant mortality, 102.8; white, 66.3. Death-rate for Negro children one to four years of age, 71; white for the same age group, 62. Negro death rate for ages five to nine years, 39; whites for the same age group, 22. Negro death-rates for age groups nine to fourteen years, 50; whites, 13.
These figures, while not complete to be sure, are representative, and show the consistently higher mortality among Negro children than among whites. Space does not allow a discussion of these rates over a term of years, but I will say that conditions are not quite as bad as they appear, because almost everywhere in the registration area, over a period of ten years, the Negro infant mortality rate has shown a great decrease. Moreover, careful studies have shown that colored children are relatively immune from certain diseases, such as scarlet fever, measles, and diphtheria. School physicians in Philadelphia claim that Negro children suffer from about one-third less eye diseases than white children.
The death-rates for Negro children in New York and Philadelphia are high, in my opinion, because the Negro hasn’t been permitted to make the industrial progress in these two cities that he has been permitted to make in Pittsburgh, Detroit, Columbus, Cleveland, Chicago and many other cities farther west. The fact is that if it were not for the splendid health programs in Philadelphia and New York for colored children, the death-rates in these two cities would be much higher.
The greatest of determining factors in mortality rates among children is the economic status of the family as determined by the father’s earning power. Another cause of high mortality rate among colored children is the lack, in many sections of the country, of health work for Negroes, particularly for Negro children. A third cause is the ignorance of Negro parents.
In the South the high mortality is aggravated by the fact that most of the Negro children live in the rural districts where there is a lack of machinery for the dissemination of health propaganda, as well as a lack of health facilities and health services such as colored public health nurses.
In the North the high mortality is aggravated by the fact that the Negro is going through a period of adjustment as the result of the migration.
We have seen the connection between the Negro’s ill health and his economic condition. This can be improved in only one way, i.e., the obtaining of better-paying jobs for Negroes. The war helped somewhat, and the fact that the Negro surprised his employer by his efficiency at that time helped more, in improving the type of jobs held by Negroes during the past ten years.
The physical environment of Negroes should be improved. In Philadelphia, during the past year, nearly 35,000 new houses were built, but not a single one was available for Negro tenancy. On the other hand, it was estimated that during the year six to ten thousand Negroes migrated to Philadelphia. A cessation of the tendency to confine Negroes to certain sections of the larger cities would help to improve conditions a great deal. The promotion of large-scale housing projects for Negroes would also help.
We should not confine our attention, however, simply to improving the economic condition of the Negro family. Such a program would be unfair to the Negro child, who is now suffering with rickets or tuberculosis and other diseases resulting from unfavorable environment. It would be unfair as well to all the other Negro children who will be born before any radical improvement can be made in the Negro’s economic condition.
The program, therefore, for the improvement of the health of the Negro child must be twofold. One phase must be economic. It must be a movement to improve the Negroes’ industrial status. The second phase must be a movement along health lines to safeguard the Negro child against the unique hazards which he must encounter.
The first step in the purely health phase of health work for Negro children should be the education of the Negro in health standards. Also, birth control information might well be disseminated among many Negro parents. The Negro as a race possesses the least wealth in the United States. For that reason it is as important for Negro parents as for any other parents to learn how to space children when too many would cause suffering or neglect.
The kind of health education that is most desirable for colored children is the kind that will inculcate in them health habits which will continue with them into adult life. The importance of sex instruction should not be overlooked. The dangers of venereal disease should be presented to both old and young. This is important because of the promiscuous way in which the sexes are thrown together in the overcrowded Negro districts of New York, Philadelphia, Cincinnati, Chicago, and the like. There should be colored public health nurses to present these matters to Negro parents and children.
It is surprising that more of the cities and health organizations which profess to be worried about the size of their Negro health problem do not call into consultation those individuals who probably know more about the problem than any other group in the community, namely, the Negro physicians.
In communities where there are separate colored schools, it is necessary to urge upon the educational authorities that the same health activities that are beneficial for white children are also beneficial for Negro children; that if open air classes and hot noon lunches are good for white “kiddies” they are also good for the colored “kiddies.”
I have one suggestion to make in addition to what has already been mentioned in regard to the extension of health work for Negro children in the North. I believe that any clinic, or hospital, or any combination of health institutions which sets out to do health work for Negro children in northern cities ought to maintain a well-planned extension service that visits the homes of the Negro newcomers, otherwise health institutions, no matter how excellent from a scientific point of view, will not reach the people that need their services most. Of course, the best type of extension workers and house-to-house visitors that could be used would be colored public health nurses.
I would like next to discuss the health work that is already being carried on for colored children. There are communities in which really worth while work is being done for colored children. Among the large cities which are doing excellent work are New York, Philadelphia, and Cincinnati. In New York a comprehensive program is being carried on in two sections of the city. In the Columbus Hill district there has been a campaign going on for a number of years. This is the poorest colored settlement in the city, and the death-rate in the past was shockingly high. It is at present much higher than it should be, but great progress has been made. Intensive prenatal work is done with colored mothers by the Association for the Improvement of the Condition of the Poor. Its program includes a full health staff with a baby and prenatal clinic doing constructive work.
In the Harlem section of New York, where Negroes are more prosperous and social conditions are not quite so deplorable as in the Columbus Hill section, a committee is actively at work, under the auspices of the New York Urban League and the New York Tuberculosis and Health Association, which brings together all the organizations interested in the health of the colored people. This is known as the Harlem Health Association. Health propaganda is carried on daily, instead of sporadically, through lectures given in churches and schools and through permanent exhibitions. Twelve colored dentists have volunteered their services for a free dental clinic for colored children.
In Philadelphia there is the Philadelphia Negro Bureau, organized by the following agencies: Phipps Institute, the Whittier Center, Jefferson Hospital, and the Philadelphia Health Council. Four clinics have been placed by this bureau in the most congested Negro districts of the city, with a staff of twelve colored physicians and nine colored nurses. The nurses visit regularly the homes of the patients who attend these clinics.
I think that Cincinnati deserves special commendation for appropriating its share of funds from the Shepard-Towner bill to the improvement of the health of Negro children. Two colored nurses have been employed, in addition to three already working for the city, and two additional clinics have been opened for colored children.
It will be noted that the comprehensive programs which I have mentioned are in communities where the death-rate as a rule is lower than elsewhere, showing undoubtedly a direct connection between low death-rates for Negro children and a program for improving the health of Negro children. Notable exceptions as have already been mentioned are New York and Philadelphia, where the death-rate for Negro children is rather high. However, one must consider what the situation was in those cities before the health movements were launched, and imagine how much higher the rate would be if it were not for them. Some excellent health educational campaigns have been carried on at regular intervals among Negroes, the best known and most thorough of which is perhaps the National Negro Health Week, which was launched by the late Booker T. Washington. This movement, while intensive for only a week, has stimulated many health movements which have become continuous.
I would like to cite a concrete situation which illustrates dramatically and vividly most of the points I have tried to make in this brief address. I wish to discuss health conditions among Negro children in the Thirtieth Ward of Philadelphia. This is the ward having the largest Negro population in the city. With an area of 51/I00 of a square mile, it has a total population of 29,471 persons, I7,325 or 52.5 per cent of whom are Negroes. The startling fact regarding health conditions among colored children in this ward is that the infant mortality for Negroes is much lower than that for whites. The average infant mortality rate for Negroes in this ward, over the nine-year period from I914 to I922, was I23.6, while for whites it was I55.3. This is a difference in favor of Negro infants of 3I.7. These figures are taken from the annual reports of the Philadelphia bureau of health for the years I914 to I922. Attention was called to them first in a Survey of Health of Negro Babies, just issued by the Whittier Center.
In conclusion, may I state that I see great reason to be optimistic about the future of the health of Negro children. Economic conditions, and consequently the home life, of the Negro is improving, and experience has shown that when the Negro child is born in a home enjoying these conditions he has as much chance to live as any other child.
Source: Proceedings Of The National Conference Of Social Work Formerly National Conference of Charities and Correction At The Fifty-Second Annual Session Held In Denver, Colorado June 10-17, 1925 — www.hti.umich.edu/n/ncosw/