Moving From the National Negro Health Week to the National Public Health Week in the United States

Abstract

There has been relatively little published on National Negro Health Week, and what has been published has often focused on physicians, nurses, or women. This article offers a brief but comprehensive overview of the organization and health emphases of nonmedical African American leaders on issues of health and explains how health concepts made their way to ordinary African Americans. In addition, in this article, I argue that the current National Public Health Week campaign might be best seen as a metamorphosis of National Negro Health Week because they share many similarities in practice and direction. The article’s main message is that the United States has a long history of a “National Health Week”; that these Weeks support the interests of subjugated groups by race, ethnicity, or class; and that these Weeks have worked to empower these groups by providing them with basic health knowledge to improve their health without needing to consult a physician.

April 2020 marks the 25th anniversary of National Public Health Week (NPHW), the American Public Health Association’s campaign to improve the nation’s health. Efforts to advance public health by dedicating a particular period of time to intensified local activities have a long history dating back to National Negro Health Week (NNHW), which began in 1915. Observance of NPHW thus provides an opportune time to examine the origins and evolution of “National Health Weeks.”

NNHW ORIGINS: BEFORE 1915

In the early 20th century, like today, African Americans had poorer health than their White counterparts. However, the health discrepancy was more pronounced. The laws of the Jim Crow South combined with less formal hiring and residential restrictions in the North to confine the majority of African Americans to the lowest paid jobs and the worst, most crowded accommodations.¹ Such conditions contributed to African Americans suffering from, and dying at, a higher rate than Whites for almost all diseases.² The crude death rate in the United States in 1900 was 17.2 deaths per 1000 people, but the African American rate was 25. In addition, the average life expectancy in the early 1900s was 49.2 years, but that of African Americans was only 35 years.³ In the South, where the vast majority of African Americans lived, researchers found that 450 000 African Americans were seriously ill at any given time and that 45% of those illnesses, such as tuberculosis and pneumonia, were preventable with basic health education.⁴

Problematically, many White physicians thought like the anonymous doctor who said, “You might as well try to teach sanitation to mules as to try to teach it to the negroes [sic].”⁵ Some believed that African Americans simply did not have the capacity to understand disease, infection, and treatment.⁶ Such conclusions led doctors to debate the utility of providing African Americans with even basic health education, such as lectures on disease and sex.⁷ And because of racial exclusions at many medical schools, there were few African American physicians to contradict these conclusions. The African American–doctor-to-African American–patient ratio in the early 20th century was 1:3000, as opposed to 1:700 for White doctors and patients, and whereas African American physicians primarily practiced in cities, most African Americans lived in rural areas.⁸

For Booker T. Washington, the principal of Tuskegee Institute and one of the most well-known and respected African Americans of his time, African American poor health, and White perceptions of that health, required a solution. Washington’s philosophy for African American racial uplift rested on economic self-determination and on an accommodationist philosophy that emphasized industrial labor and honing a skill.⁹ Sick African Americans could not improve their economic status or prove their worth. Although African Americans did organize campaigns for health improvement, their often limited financial means and their focus on local concerns made them insufficient to change the race’s outlook nationally.¹⁰

THE FIRST NNHW: 1915

With the power of Washington’s name and the “Tuskegee Machine’s” connections to African American newspapers and social, professional, and religious organizations, NNHW began in 1915. The program targeted issues that poor African Americans, particularly those in the South, could solve in their limited spare time, making the “National” part of NNHW a bit of a misnomer at this early stage.¹¹ The first NNHW had six goals:

• 1.removing and burning trash;
• 2.dusting furniture;
• 3.cleaning and painting walls, ceilings, and floors;
• 4.cleaning yards;
• 5.repairing stables and barns; and
• 6.keeping wells and outhouses in clean and working order.¹²

The Week’s aims reflected Washington’s interest in improving African American health and ensured that Whites could recognize African Americans’ efforts at health improvement. Three of the six goals had to do with outward appearance—what passers-by could see. For Washington, health was a social construct tied to race, and the more obvious the improvements, the more likely Whites were to perceive African Americans as adopting White health standards and to think better of the race. Washington hoped that, over time and through the campaign, White perceptions of African Americans would improve and lead Whites to extend more rights and better treatment to African Americans.¹³ In addition, because germs did not respect the color line, Washington thought Whites would support African American health improvement out of their own self-interest, which could cause a chain reaction of caring about African American welfare in other aspects and greater cooperation between the races.¹⁴ Combined with the health information NNHW provided to African Americans, this campaign had the potential to give African Americans access to the tools and resources to take ownership of, and vastly improve, their health and economic potential.

To achieve this goal, Washington, in contrast with medical professionals, used the term “healthy” to mean “clean outward appearance.” A “healthy” person was one who had no visible dirt on his or her skin. Similarly, a “healthy” home was one without peeling paint or trash in the yard. While a clean body and home would help stave off disease, the omission of advice regarding specific medical practices or treatment allowed participants to decide for themselves if they were healthy. In short, one did not need to consult a doctor, take physician-prescribed medicine, or get vaccinated to improve one’s health. While these were all good steps to take to achieve good health, the lack of access most African Americans had to medical professionals, because of location and racism, made the Week’s emphasis on personal action to support health a necessity. The Week’s emphasis also aligned with the greater “black discourse about domestic spaces [which] maintained that the weal or woe of African Americans was bound up in the purification of home environments.”¹⁵

While NNHW ideas were not novel, the scale was. The first NNHW had extensive support. The Indianapolis Freeman reported that “Never before has there been such a widespread co-operation of the races in a movement for the general good.”¹⁶ In addition to the participation of African Americans from all backgrounds, classes, religious denominations, and areas, rural and urban, the newspaper noted that “The health department of every Southern State, [and] of many of the cities in the South . . .” supported the Week, along with the state departments of education in Arkansas, Tennessee, and North Carolina.¹⁷ The popularity of the Week meant that, even after Washington died in November 1915, support for the campaign remained strong, encouraging Tuskegee’s new leader, Robert Moton, to continue NNHW and seek out new partners, including the US Public Health Service (USPHS).

NNHW AND THE USPHS: EARLY PARTNERSHIP, 1921–1931

From Moton’s perspective, the USPHS could help the campaign in several ways. First, any support at all from the USPHS, an agency of the federal government, would legitimize the Week in the eyes of both Whites and African Americans. Second, the USPHS’s connections to state, county, and city health departments would provide wider support for the Week. Third, the USPHS provided another significant media outlet to promote the Week.

For US Surgeon General Hugh Cumming, the Week represented an opportunity to establish the Service’s credentials. In the early 1900s,

Private physicians and their powerful professional organizations frequently thwarted the PHS’s efforts . . . at the delivery of care [which] were often denounced as the beginnings of “state” medicine.¹⁸

NNHW provided Cumming with a way to legitimize USPHS health authority with a group of people medical leaders often overlooked. Indeed, the Week’s mission and goals aligned with those of the USPHS’s where “‘Cleaning up’ was always central to the service’s expanded role; the provision of privies and clean water was often at the core of its public health work.”¹⁹ For these reasons, the USPHS agreed to publish the Week’s annual health bulletin and otherwise publicize the Week.²⁰ USPHS endorsement quickly led a variety of new groups to support the Week, such as the National Tuberculosis Association, Federal Children’s Bureau, and American Red Cross.²¹ However, all these new developments and increased publicity came with a caveat: USPHS participation in the campaign’s direction and scope. Given the opportunity to deliberate on African American health, the Service began to question its emphasis on personal health and health displays, instead promoting orthodox medical professionals as the ultimate arbiters of health.

The effect of enhanced medical professional leadership in the Week was best seen in the Week’s bulletin. Over the course of the 1920s, the bulletin included more detail on the types of illnesses African Americans should worry about, concentrating on venereal diseases and tuberculosis, and placed an ever greater emphasis on the need for African Americans to get vaccinated and see a physician, especially if they suffered from these diseases.²² The Week’s turn toward disease education made those with detailed medical knowledge a necessity. While nonmedical professionals could still lead on health issues, they were now nudged to work closely with physicians. The increased focus on the knowledge of medical professionals also mitigated some of the emphasis on health displays, signaling that cleaning and whitewashing were not enough to improve poor African American health. In short, under the USPHS, the bulletin began to assert that what one did internally had as great an impact on health, and perceptions of health, as what one did externally.

During the 1920s, the formal structure of the Week became solidified. Each year had a theme, and each day had a particular focus. The Sunday the Week began was Mobilization Day, a day dedicated to publicizing the need for NNHW and the Week’s activities. Because about one in three African Americans was a member of a religious institution, the primary way to motivate participation was to coordinate with ministers who often dedicated sermons to kicking off NNHW.²³ As NNHW Committee member F. Rivers Barnwell explained, “We have found that the race on a whole listens to the minister.”²⁴ In addition to the sermon, many communities held a mass meeting that included music and entertainment to, as Algernon Jackson, MD, another NNHW Committee member put it, “make health the fashionable thing.”²⁵

After mobilization, NNHW days focused on discussing and improving health in the home, at school, in children, in adults, and in the community; coordinating a general cleanup; and conducting a special campaign against a community health menace.²⁶ For the Special Campaign Day, which first began in 1927, some communities focused on precise medical objectives, such as vaccination drives against smallpox, while others worked on less measurable concerns, such as raising awareness about what constituted proper living conditions.²⁷ Regardless of the day, NNHW observances included health talks featuring medical and nonmedical professionals, demonstrations of proper health, such as appropriate meat preparation or human waste removal, films and radio addresses on diseases, and health plays, pageants, and parades.

The final day of the Week was for recording participation and activity data. These statistics told the story of an ever-expanding campaign, both by participation and geography. In 1930, 31 states, including practically every state between Connecticut and Texas, had at least one community participate in NNHW as the USPHS’s publicity campaign for NNHW combined with the Great Migration that saw African Americans move out of the South and across the country in search of greater economic opportunities, taking their interest in NNHW with them. By the end of the 1920s, one fifth of all African Americans lived in Northern and Western states and one third in cities and towns, pushing NNHW beyond, “the rural people, the farming element.”²⁸ Indeed, the Baltimore Afro-American reported that the 1930 NNHW reached one million people—10% of all African Americans.²⁹ Yet even with all the publicity and participation, financial constraints from the Great Depression forced the Week’s headquarters to relocate from Tuskegee Institute to Howard University and eventually led the Week’s leaders to turn to the USPHS to run the campaign.

NNHW AND THE USPHS: LATER PARTNERSHIP, 1932–1940

The establishment of the Office of Negro Health Work within the USPHS in 1932 to coordinate NNHW represented a significant achievement for African Americans. As Jesse O. Thomas of Atlanta’s National Urban League explained,

That the federal government has adopted the Negro Health Week as its own project is an unmistakable testimony that the government has recognized the beneficial results that have come from the activities of this organization . . . and it is disposed to assume a larger share of its responsibility in connection with the health of this frequently, ‘forgotten 10 per cent’ of our population.³⁰

The takeover legitimized the place of African American health as a national priority and established a pathway for future government aid to support African American health improvement and outreach throughout the country. USPHS control of NNHW provided “a communication bridge for the federal public health movement into the black lay community at the local, personal, household level.”³¹ At this level, the government could direct the health priorities and values of the African American community through the NNHW campaign African Americans trusted and associated with their race’s leadership.

With the USPHS in charge, NNHW Chairman Roscoe Brown, an African American dentist, characterized the Week’s two objectives as

(1) To provide practical suggestions for the local Health Week Committees that conduct the observance, and (2) to stimulate the people as a whole to cooperative endeavor in clean-up, educational, and specific hygienic and clinical services for general sanitary improvement of the community and for health betterment of the individual, family, and home.³²

Brown’s aims for the Week were similar to those Washington outlined in his original program in that they mostly focused on health education and community cleaning. To encourage greater participation, Brown introduced a national radio address, a national health sermon, community certificates and awards for participation, and a poster contest. Brown designed the certificates, awards, and contests to stimulate interest in health beyond the Week in an attempt to create a year-long movement.³³ However, as Brown explained, as the Week grew, it “naturally and logically assumed other phases of health conservation, such as clinics for treatment, inoculation, and period health examination.”³⁴

These new NNHW elements supported the power of the burgeoning medical professional community. For instance, the Week introduced a “Better Babies Certificate of Examination” in 1932. During NNHW, parents regularly took their children to clinics and physicians. The certificate required the medical professional to check the child for proper physical and mental development and assign the patient a score.³⁵ These certificates supported Washington’s idea of proving African American health, but the involvement of medical experts opposed Washington’s vision of giving the African American lay public the tools to improve their health on their own. Indeed, the rating system implied that medical experts were the lone judges of health improvement as only they could assign scores.

THE DEMISE OF NNHW: 1940–1951

Regardless of the potential for White oversight, the Week’s continued growth, counting as many as four million participants in 1941, created a situation in which a popular and ostensibly useful health campaign singled out a particular segment of the population.³⁶ The Week coincided with a significant increase in African American health: between the 1920s and 1949, African American life expectancy increased at a greater rate than that of Whites. For males, the increase was about 10 years, giving them a life expectancy of 57.5 years compared with an improvement of six years for Whites, who averaged 65 years of life. For females, African Americans increased their life expectancy by almost 16 years to just under 63 years of age, while White women improved by a little less than 10 years to expect to live to 72 years.³⁷ Although developments in waste removal, sanitation, medicine, and municipal services promoted these health improvements, Moton claimed that NNHW “may be regarded as an institution definitely contributing to better health habits and the prevention of disease.”³⁸ From this perspective, Robert Olesen, a White assistant surgeon general, declared, “it is the hope that the benefits of National Negro Health Week may be made available to the white population as well.”³⁹

However popular the campaign, during the 1940s, a growing number of African American physicians and professionals grew increasingly concerned that NNHW implied that African Americans faced different health concerns than their White counterparts, meaning that NNHW was helping to segregate, not integrate, health. As the Pittsburgh American put it, “a Jim Crow Health Week is an admission of physical inferiority and mental weakness on our [African Americans’] part.”⁴⁰ The emphasis on health patriotism that occurred during World War II, which promoted proper health as the duty of every American regardless of race, sparked the National Association for the Advancement of Colored People (NAACP) and the National Medical Association to campaign for desegregation in health practices, turning a critical eye toward the Week.⁴¹ According to the Philadelphia Tribune, at the close of the city’s 1944 NNHW campaign, “public opinion opposed the designation of health as a racial difference.”⁴² Philadelphians, while interested in health programs, did not support the “Negro” part of the Week. The following year, the Chicago Defender celebrated that “many communities and areas sponsor ‘Health Weeks’ now with no reference to race.”⁴³

Perhaps it was the conglomeration of these movements—that is, African American advocacy for integration in health; the beginning of the trend toward removing racial barriers, with President Truman gradually integrating the Army and being the first president to speak before the NAACP; and the Supreme Court’s abolition of “racial covenants” in housing in 1948—that led the USPHS to terminate NNHW in 1950. The Journal of the National Medical Association attributed the decision to it being “time that Negro health ceased to be considered as a special and separate kind of health, apart from that of the general population.”⁴⁴ Indeed, the Journal portrayed this decision as part of a pattern of increased integration efforts throughout the medical profession. The National Association of Colored Graduate Nurses (NACGN) voted to dissolve after the American Nursing Association decided to integrate, and a variety of state and local medical associations eliminated their racial qualifications for membership.⁴⁵

Within the confines of health, the end of the Week also had important overtones. As the historian David McBride explains,

Ironically, this [the termination of NNHW and the NACGN] meant that those black institutions traditionally most effective in stimulating community health projects throughout the nation’s black population were merged into larger, predominately white-controlled organizations.⁴⁶

The African American voice in medicine, such as it was, shrunk significantly in 1950–1951. The USPHS disbanded the Office of Negro Health Work. In its place, it created the Special Programs Branch to publish articles on African American health in USPHS journals and coordinate health efforts for African Americans with those of Whites, joining African American health issues with the health of the entire nation.⁴⁷ Without the NNHW and NACGN, it was now up to the few African American, and many White, medical professionals to improve racial equality in their area of expertise. That inequality in health, by race or income, remained was part of the basis for the establishment of Public Health Week, which, after beginning in the Los Angeles County Department of Health Services in 1988, became a national campaign when President William J. Clinton officially designated it in 1995: National Public Health Week.⁴⁸

NNHW AND NPHW: A COMPARISON

Ostensibly, the 2 Health Weeks have little in common (see the box on page 475). While NNHW’s goal was to improve African American health, NPHW’s is “to recognize the contributions of public health and highlight issues that are important to improving our nation.”⁴⁹ Instead of focusing on one particular racial group, the American Public Health Association designed NPHW to address the health problems of all types of people: low-income Whites, Native Americans, Hispanics, Asian Americans, and even seniors. Given these divergent target populations and the combination of advances in public health, technology, and race relations, it seems self-evident that NPHW would conduct a completely different campaign from NNHW.

Brief Overview of Similarities and Differences Between the National Negro Health Week (NNHW) and the National Public Health Week (NPHW).

Similarities	Differences
Have federal government endorsement	NN HW is focused on improving health outcomes for one race; NPHW is focused on improving health outcomes for all.
Create annual and daily themes to coordinate each campaign
Emphasize that diseases cross boundaries	Medical professionals were not part of the original NNHW Committee. Medical professionals have always been part of NPHW leadership.
Empower ordinary people to improve their health
Stress that economic and social inequality is tied to health outcomes

Note. This box provides an overview; there are many more nuances that can be added to both columns.

Yet, in the context of scientific advances that have demonstrated the similarities in health issues across race, NPHW might be better seen as a metamorphosis of NNHW. One area of similarity is the idea that diseases cross boundaries. For NNHW, those borders were race. As Washington put it, “germs know no color line,” and throughout NNHW’s campaigns, leaders made efforts to connect African American health with White health.⁵⁰ For NPHW, boundaries are about space, not race. As Robert James Kim-Farley, associate editor of AJPH, put it, “Borders and geographic distances are increasingly irrelevant to the agents of disease in our ‘global village.’”⁵¹ Diseases do not recognize territorial divisions and country borders, just as they do not see skin color. In this way, both Weeks promote the idea that ordinary people must work together to share information on health and improve the health of all, not just some.

This discussion illustrates another important theme between the two weeks: empowering ordinary people. According to NNHW Committee Member Monroe Work, the Week’s annual health bulletin “was intended for the layman – to give information and inspiration – so that any one [sic] who got hold of it could use it.”⁵² Early NNHW materials provided how-to guides that taught readers about proper sanitation and hygiene. Later NNHW bulletins included photographs of NNHW activities to illustrate what participation looked like. For NPHW, the discussion on individual actions has evolved and ranges from “eating healthy, avoiding tobacco, receiving vaccinations, and using seatbelts,” to the basics of how to avoid accidents and injury.⁵³ Both Weeks focus on using simple examples, instructions, and information to empower those in the unhealthiest situations to uplift themselves and improve their health. Both advocate physicians as a good source for health maintenance but perceive medical professionals as one of a number of resources in promoting good health. Thus, both emphasize the individual as having primary control over well-being.

One other notable connection between the two Weeks is the way in which each expands its discussion of health to greater issues of inequality. Some NNHW meetings concentrated on Jim Crow practices and the “criminally negligent,” inequities African Americans faced not only in health, but also in economics, education, and municipal services.⁵⁴ Others focused on access to the franchise, tying health to politics.⁵⁵ Similarly, NPHW connects health problems, particularly those in working class and poor neighborhoods, to greater issues of inequality. As New Mexico Senator Tom Udall put it in promoting NPHW, “We know that food contributes to a longer life. But it is difficult to choose a healthy diet if you live in a community without access to a store that sells affordable, fresh produce.”⁵⁶ NPHW highlights the roles that poverty, housing, education, the environment, and even transportation have in affecting health and implementing best practices.⁵⁷ In this way, the connections that NPHW makes between health and other facets of life are similar to the appeals African Americans made decades earlier during NNHW, but with a wider scope that engages a much greater variety of people of diverse backgrounds.

The major problem that challenges NPHW is the same one that Washington faced when he started NNHW 105 years ago. As Udall stated,

We often think of good health as something that happens in a doctor’s office. The unfortunate reality, however, is that even the best medical care in the world will not solve some of our nation’s most pressing health problems.⁵⁸

For Washington, those problems were the treatment and perceptions of African Americans and their health. Today, although we have come far, these problems remain and are not limited by race. NPHW provides us with an opportunity to reflect on how much we have done to improve our health; how our health affects a wide range of issues, opportunities, and people; and how we can hone our efforts to improve the health and, therefore, the treatment and well-being of those around us.