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The history of public health is also the history of women in health care. Let’s take a moment to reflect on how the discipline of public health arose out of social justice reforms in the late 19th and early 20th centuries.
HISTORY OF MEDICINE THREAD 1/
HISTORY OF MEDICINE THREAD 1/
The second half of the 19th century saw an increasing appreciation of the health consequences of poverty. Among other factors, the development of germ theory created an understanding of how the crowded, unsanitary conditions of slums propagated infectious disease. 2/
At the same time, women were fighting for a greater voice in all aspects of public life. A popular suffragist argument was that women had unique skills and traits that could balance the harms men caused to the world. 3/
Women’s involvement in social reforms were painted as the extension of an innate maternal drive. Activists argued that expanding the maternal instinct towards society would benefit everyone.
(Sidebar: the history of temperance is a fascinating demonstration of these ideas.) 4/
(Sidebar: the history of temperance is a fascinating demonstration of these ideas.) 4/
Middle and upper class women became pioneers in multiple overlapping social and health reform movements in this period. They were active in organizing child labour laws, sanitation, unionizing, maternal and child health programs, vaccination, contraception and more. 5/
Historian Barbara Melosh has suggested that nurses enjoyed the autonomy of public health work and found it an escape from the role of doctor’s helper in the hospital setting. Nurses quickly took over the nascent discipline when doctors showed little interest in its early yrs. 6/
The few women who became doctors at this time were also drawn to public health. It was again seen as a natural extension of their biology.
It was also low paying, setting up a dynamic of #WomenInMedicine doing necessary but low paying work that persists to this day. 7/
It was also low paying, setting up a dynamic of #WomenInMedicine doing necessary but low paying work that persists to this day. 7/
Most famous perhaps is Sara Josephine Baker, the NY doctor who became Chief of the NY Child Hygiene Division, the first in the country. Baker is best known for helping to apprehend “Typhoid Mary”, but her work in pediatrics led to a big drop in infant mortality and morbidity. 8/
In Canada, a nurse named Eunice Dyke was a child health pioneer in the early yrs of Toronto Public Health pre-WW1. Her influence shaped public health efforts around the family as a nucleus and structured health units as decentralized offices serving their districts. 9/
I have already tweeted about Sophia B. Jones, the Ontario-born doctor who was forced by sexism and racism in Canadian academia to seek out a medical education in the US.
She was a public health pioneer in African American communities. 10/ https://twitter.com/DocMCohen/status/1236674261206683648
She was a public health pioneer in African American communities. 10/ https://twitter.com/DocMCohen/status/1236674261206683648
It would be wrong to elide the classist and racist underpinnings of much of early public health work. Coming from a tradition of wealthy women helping impoverished groups, this type of altruism was served up with a heavy dose of paternalism and moral superiority. 11/
Cities like NYC, who developed some of the first public health programs, were in part dealing with a massive influx of migrants into slums who were disconnected from the community health traditions of their countries of origin. 12/
The practice of sending educated white women into poor, racialized communities to teach child health and sanitation is inherently problematic.
In Canada, public health work with Indigenous communities has deep roots in colonialist attitudes and policies. 13/
In Canada, public health work with Indigenous communities has deep roots in colonialist attitudes and policies. 13/
And we can’t ignore the fact that while some public health pioneers were social justice reformers in the progressive tradition, some were eugenicists like Canada’s Helen MacMurchy. 14/
MacMurchy championed the sterilization of migrants in Toronto and her public health work in pediatrics was based upon her fears of the “white race” dying out.
She made notable achievements in infant mortality, but her legacy can’t be appreciated without her bigotry. 15/
She made notable achievements in infant mortality, but her legacy can’t be appreciated without her bigotry. 15/
The history of public health is a crucible for the vital social and scientific advancements of the turn of the 20th century.
The poverty, labour and women’s liberation movements combined with a growing understanding of sanitation, germ theory and the advent of vaccination. 16/
The poverty, labour and women’s liberation movements combined with a growing understanding of sanitation, germ theory and the advent of vaccination. 16/
Women were on the forefront of early public health work, which ultimately stems from
1)women’s activism to be included in public life
2)classist and racist ideas around impoverished communities needing the guidance of white women’s maternal instincts. 17/
1)women’s activism to be included in public life
2)classist and racist ideas around impoverished communities needing the guidance of white women’s maternal instincts. 17/
It’s a complicated history but one I find super interesting to read about. Thanks for reading along!
FIN
Sources:
https://www.ncbi.nlm.nih.gov/pubmed/2663922
https://cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf
http://www.pearsoncanada.ca/media/highered-showcase/multi-product-showcase/stamler-ch04.pdf
FIN
Sources:
https://www.ncbi.nlm.nih.gov/pubmed/2663922
https://cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf
http://www.pearsoncanada.ca/media/highered-showcase/multi-product-showcase/stamler-ch04.pdf
