Making ends meet.

PUBLIC HEALTH THEN AND NOW

Making
ENDS Meet
Community Networks and Health Promotion Among
Blacks in the City of Brotherly Love

| Margo Brooks Carthon, PhD

This historical inquiry illustrates the power of social networks by BLACK AMERICANS HAVE public health practitioners, aware
examining the Starr Centre and the Whittier Centre, two civic as- historically experienced worse of the relationship between poor
sociations that operated in Philadelphia during the early 20th health outcomes and much lower health and social conditions, initi-
century, a time when Black Americans faced numerous public life expectancy than have their ated campaigns to decrease urban
health threats. Efforts to address those threats included health White American counterparts. blight and prevent communicable
initiatives forged through collaborative social networks involving These trends, although notable diseases. These programs, how-
civic associations, health professionals, and members of Black today, were equally prevalent ever, often failed to adequately
communities. Such networks provided access to important
nearly a century ago, when Blacks address the needs of growing
resources and served as cornerstones of health promotion ac-
faced persistent health threats urban Black communities. Hence,
tivities in many large cities. I trace the origins of these two cen-
ters, the development of their programs, their establishment of because of the cumulative impact left with a scarcity of resources
ties with Black community residents, and the relationship be- of infectious diseases, poverty, from municipal agencies, Black
tween strong community ties and the development of community and limited health resources.1 community members turned
health initiatives. Clinicians, researchers, and community health During the second decade of the inward toward their own private
activists can draw on these historical precedents to address con- 20th century, stark disparities in civic associations to meet their
temporary public health concerns by identifying community health between Blacks and Whites health and welfare needs.3
strengths, leveraging social networks, mobilizing community mem- drew the increased attention of Civic associations during this
bers, training community leaders, and building partnerships with public health officials in northern period were characterized by
indigenous community organizations. (Am J Public Health. cities as large numbers of rural progressive ideals and an agenda
2011;101:1392–1401. doi:10.2105/AJPH.2011.300125.)
southern Blacks left agricultural of social reform. As Smith and
settings in search of jobs and Hine demonstrate in their work
increased social freedom in the on Black club women, these
north.2 Upon their arrival in social welfare organizations laid
northern metropolises many of the roots for the implementation
their dreams were dashed as they of many large-scale public health
encountered substandard housing, reform initiatives.4 For Blacks in
hazardous working conditions, the early 20th century, member-
and poor sanitation. A number of ship in civic associations such as

1392 | Public Health Then and Now | Peer Reviewed | Carthon American Journal of Public Health | August 2011, Vol 101, No. 8


mission societies, charity organi- development and operation of health. Many of the norms, values,
zations, churches, women’s clubs, community health programs war- and institutional infrastructures
mutual aid societies, and benevo- rants more attention. The accom- present in Black communities in
lent associations provided access plishments of many community the early decades of the 20th
to important public services and health programs depended on a century remain in place today.
a network of social support. civic association’s ability to estab- Thus, a fuller appreciation of the
Because of their long-standing lish a sense of group cohesion dynamic and reciprocal nature
work in many Black communi- and trust among community of these relationships can serve
ties, civic associations held posi- members. This was particularly as templates for public health
tions of prominence in those true among members of Black activists who strive to create
communities, helping to form the communities, who for centuries sustainable health coalitions
fabric of social order by promot- relied heavily upon institutions among diverse communities
ing messages of uplift, thrift, and such as churches and benevolent today. Moreover, Black communi-
personal responsibility. Most civic
associations were financed by
dues collected from their constit-
uents or by contributions from
wealthy donors and were located
in poor immigrant and Black
communities. Several offered
health services through dispensa-
ries or by nurses who were hired
to provide care in the home.5
The popularity of civic associa-
tions grew steadily during the
Progressive Era because they
offered a wide variety of services.
For the Blacks they served, civic
associations brought relief from
the often complex burden of ill-
ness, social isolation, and eco-
nomic need. Blacks experienced
high rates of tuberculosis (TB),
so they were interested in civic
programs pertaining to health societies to meet their health, ties continue to experience health Cooperative Coal Club
and disease prevention. These social, and welfare needs. Here I disparities in the form of dispro- Source. Starr Centre, "Annual Report," 1911.
programs were primarily focused describe support networks devel- portionate rates of HIV/AIDS Reprinted with the permission of the Barbara
Bates Center for the Study of the History of
on health promotion, but they oped with the aid of two civic and other chronic illnesses. If a
Nursing, University of Pennsylvania.
also provided opportunities for associations—the Starr Centre central tenet of public health
middle-class and working-class and the Whittier Centre—to sup- activism is the engagement of
Blacks to socialize with one port Blacks in Philadelphia, Penn- local residents in the development
another and with White philan- sylvania, during the early 20th and implementation of health ini-
thropists in the larger community. century. I highlight the origins tiatives, then this case study is
Over time, relationships between and programs of the associations, valuable because it highlights the
community members of diverse their establishment of ties with benefits of these efforts.
racial and class groups led to a the Black community, and the
growing sense of civic unity and relationship between building THE STARR CENTRE
laid the foundation for the subse- strong community ties and the CREATES EARLY TIES
quent development of a number development of health initiatives.
of community health initiatives. The events examined here In the early 20th century, Phil-
Civic associations have long occurred a full century ago, but adelphia experienced a cataclysm
occupied a prominent position in they hold lessons applicable to of immigration in the midst of
US society, and their role in the 21st-century issues in public rapid industrialization. Like other

August 2011, Vol 101, No. 8 | American Journal of Public Health Carthon | Peer Reviewed | Public Health Then and Now | 1393


northern cities during this period, civic-improvement efforts By the time of his death in
Philadelphia witnessed an launched by its benefactor, 1884, Starr’s social-welfare initia-
upsurge of immigrants and rural White social progressive Theo- tives were well entrenched within
Blacks migrating from the south. dore Starr (1841–1884).9 Philadelphia’s Black community.
Between 1890 and 1910, the During his lifetime, Starr was Starr’s legacy continued through
city’s Black population increased recognized as a keen business- the efforts of several long-time
more than 100%, to 84 000, in man and philanthropist with a acquaintances, including Susan
a city with a total population of deep commitment to poor Black Parrish Wharton, a well-known
1.5 million; by 1920, the Black and immigrant families living in community member and civic
population grew to 134 000 in the fourth, fifth, and seventh activist. When the Starr Centre
a total population of 1.7 million.6 wards of Philadelphia. His con- was founded in 1897, Wharton
As Philadelphia’s newest residents cern for the social welfare of served as chairperson and presi-
packed into cramped dwellings, local residents led to the develop- dent. Wharton and her colleagues
TB and other infectious diseases ment of a number of initiatives, stated that the Starr Centre Asso-
gripped the city, and housing including public playgrounds and ciation’s aims were
conditions began to rapidly deteri- gardening centers for neighbor-
[to] provide for and promote by
orate.7 Progressive reformers hood children. Starr’s desire to practical methods, the educa-
battled the growing threat of improve the quality of life for tional and social improvement
infectious disease and urban decay local Blacks led him to establish of those poor neighborhoods;
primarily in the vicinity of the
by establishing a variety of chari- Philadelphia’s first Progressive Starr Garden.11
ties, including settlement houses, in Working Colored Men’s Club
which middle-class volunteers lived (1878) and the city’s first Penny The settlement operated with
as settlers in low-income areas Bank (1879), where Blacks could a modest budget and consisted
Coal Club, "Ready for the Lecture and worked to serve the poor.8 save small amounts of money to of a board of directors, donors,
to Begin" During this turbulent time be used for planned purchases various committees, and neigh-
Source. Starr Centre, "Annual Report," 1906. the Starr Centre, a settlement later. Starr also purchased plots borhood residents. The Starr
Reprinted with the permission of the Barbara
Bates Center for the Study of the History of organized in 1897, became a of land that were used to build Centre’s programs included
Nursing, University of Pennsylvania. clearinghouse for the numerous affordable homes for Blacks.10 classes in domestic art and
carpentry, the provision of inex-
pensive lunches and milk for
schoolchildren, health lectures,
visiting nursing services, and
dispensaries for medical care.12
Local residents gained access to
association membership by con-
tributing one dollar annually.
Over the course of the next
decade, Starr Centre programs
increased in popularity among
local immigrant and Black
families.13
Starr Centre leaders were par-
ticularly interested in health pro-
motion and disease prevention.
In 1905, the Starr Centre created
a medical department and con-
tracted with the Visiting Nurses
Association of Philadelphia to
provide nursing care to sick
children and adults in clinics and
homes.14 Despite the excessive ill-
ness present in the Black commu-
nity, many families were forced



to juggle their participation in the Coal Club’s members repre- from 300 to 400 individuals
health programs and visits to sented a cross section of working- would assemble to hear health
local clinics with more quotidian class and middle-class Blacks lectures and to discuss club
domestic concerns, such as find- who were unlikely to meet in affairs. Like other mutual aid and
ing coal to warm their homes or other settings because of different benefit societies, the religious,
food to fill their children’s hungry class or church affiliations.18 In secular, social, and political pur-
stomachs. Even as infectious dis- the opinion of Susan Wharton, poses of the Starr Centre and the
ease rates spiked among Blacks, manager of the Coal Club, this Coal Club sometimes overlapped.
poor families were frequently convergence of individuals from Meetings called to discuss the
obliged to work long hours different social strata and denom- cost of coal were often followed
instead of seeking medical care. inational affiliations was of signifi- by singing hymns, enjoying
Starr Centre board members saw cant value, for common concerns refreshments, and socializing.22
this dilemma and realized that emerged in During these gatherings, mat-
any efforts to curtail excess sick- ters pertaining to illness and mak-
ness had to address the limited [the] pulling together and . . . ing provisions for poor health
good fellowship growing up
material resources of community were commonly discussed. A
among people of varied occupa-
members first.15 tions and interests and belonging recurring topic among club mem-
to many different churches.19 bers was the lack of good medical
Building Community and nursing services.23 Although
Resources The Coal Club’s open mem- the city’s Blacks could seek care
One of the Starr Centre’s early bership policy allowed it to serve from local health departments,
efforts to address the pressing as more than just a way to obtain neighborhood health centers, and
economic needs of Black commu- necessary material resources; the city hospital (Philadelphia
nity residents began with the ini- over time it helped foster a General Hospital), treatment and
tiation of the Cooperative Coal diverse set of social networks services at these facilities were
Club. The Coal Club was created among its members. often of limited availability and
as a way to help Blacks by offer- From the early years of its poor quality. Philadelphia Gen-
ing them protection from unscru- inception throughout the first eral Hospital, for instance, was
pulous merchants who were decade of the 1900s, the Coal frequently overcrowded and in
known to sell coal at inflated Club’s membership steadily grew, disrepair. Philadelphia’s two
prices.16 Many Black city resi- as did the number of club-spon- Black-run hospitals, Frederick
dents relied on hard coal as a fuel sored functions. Prompted by the Douglass Memorial Hospital
source for cooking and heating club’s growth, the Starr Centre (established 1895) and Mercy
their homes. Meager weekly purchased a second property at Hospital (established 1907),
wages, however, forced poor and 18th and Webster Streets in extended services to Blacks, but
working-class families to buy coal 1911 that was soon recognized neither hospital had beds for
in small amounts. Buying coal in as a central meeting space for patients infected with TB, so they
these small bucket portions often Blacks living in the community.20 were unable to meet this critical
meant paying higher costs per Coal Club members used the need among Philadelphia’s grow-
pound. The Coal Club offered a newly purchased house for ing Black community.24
way out of this trap by allowing monthly social and business pur- Faced with the constant threat
members to form a cooperative poses, and frequently stopped in of illness, Coal Club members
for the purpose of buying coal in for social calls and to seek advice worked with Starr Centre organiz-
large quantities, thus bringing from Starr Centre staff.21 The ers to form the Rainy Day Society
down the price.17 space was also used for monthly in 1905. Similar to many other
The Coal Club drew its mem- Coal Club meetings attended by sick benefit societies in cities
bership from the area south of women, men, and children from across the country, the Rainy Day
Lombard Street and reflected the across the community. These Society served as a safety net for
diverse backgrounds of Blacks meetings provided a venue for its members by providing financial
living there. Unlike some frater- fellowship and discussion of protection against the devastation
nal societies and social clubs, important community topics. At that unexpected illness caused.
which offered membership to larger monthly gatherings, often Individuals joined the Rainy Day
Blacks on an exclusionary basis, held at local churches, anywhere Society by paying annual dues



over the course of the year in inspire.”28 In 1911, the Rainy approach the Starr Centre board
small weekly payments. An Day Society and Coal Club of directors with a plan for
all-White staff of paid Starr Centre together had more than 900 expansion. In a meeting on May
visitors collected the payments by paid members, and visitors that 28, 1912, board members dis-
making personal calls to the home year made more than 41 000 cussed the merit of Wharton’s
of each member. At each visit the home visits.29 Members fre- “Plan for Readjustment,” which
typical payment was 10 to 15 quently asked visitors to “please was designed to increase the ser-
cents. Monies received from Rainy call on my aunt, who wants to vices that the Starr Centre
Day Society members were join” or “my cousin or friend.”30 offered specifically to the Black
deposited into the Starr Savings The Starr Centre’s philosophy of community. After lengthy discus-
Bank and kept in a trust for mem- “active touch” between the sion, the board resolved that it
bers in the event that they had an trained visitors and Coal Club would be unwise to undertake an
emergency that required use of and Rainy Day Society members expansion of its work for Blacks,
the funds.25 Society members helped to foster a “mutual under- though it hoped to continue pro-
could also withdraw their total standing and confidence,” result- viding such services at its present
savings at the beginning of each ing in an inspiring partnership pace, with their “growth encour-
year for other purchases. that would endure.31 aged at a normal but steady man-
In time, the small amounts of What did it mean for White ner.”33 The decision for limited
savings contributed by club visitors to have such open access expansion did not indicate an
members steadily grew in value. to the homes of Black club mem- unwillingness to provide services
In 1905, visitors made 6394 bers? Certainly there was the risk to Blacks; rather, it reflected a
home-collection visits, through that interracial and class tensions reluctance to try to increase
which Rainy Day Society mem- might emerge during these inter- them. It must be recalled that the
bers collectively saved $967. By actions. Indeed, other historical Starr Centre was never intended
1909, those figures had dou- examples of interracial settle- to address the needs of Black res-
bled.26 One society member said, ments and civic associations dur- idents exclusively, and such an
“I tell you this saving thing is a ing the same period reveal expansion might have threatened
great thing; when sickness comes, significant discord between asso- or undermined the center’s out-
you have the money, when death ciation leaders and Black mem- reach to other poor or immi-
comes, you have the money, and bers.32 Conversely, the Starr grant constituents of south
when you want to . . . go down Centre appears unique because Philadelphia.
home [south] you’ve got the of the absence of overt class and On June 11, 1912, the matter
money for that.”27 racial bias in its annual reports. Its of expansion of services in the
Most of the members of the records instead display the condi- Black community was again
Rainy Day Society were also tions that allowed these weekly taken up at a Starr Centre board
members of the Coal Club. This interactions to solidify the bonds meeting in which it was unani-
dual affiliation allowed members of trust and mutual respect, set- mously carried that:
to access a range of services ting the groundwork for the sub-
if an independent agency, as
formed to address material and sequent development of other capable as ourselves of carrying
health needs. The Starr Centre health initiatives. As visitors on effectively the present objec-
coordinated its services with the became eyewitnesses to the con- tives of the Coal Club and Rainy
Day Society be formed, we
Coal Club and the Rainy Day ditions and home lives of club should be willing to consider a
Society through frequent visits to members, they took with them a transfer to that organization of
the homes of club members. deeper knowledge of the needs our work in connection with in-
dividuals living out of the Starr
While in members’ homes, Starr of Black residents that then Centre neighborhood.34
Centre visitors were charged with translated into the programmatic
collecting dues, learning about efforts of the Starr Centre. On October 8, 1912, Wharton
members’ living conditions, and tendered her resignation as
offering assistance or referrals Growth and Division founding member of the Starr
when needed. By building rela- In 1912, the ever-present Centre board. Within the month
tionships and offering “constant needs and continued growth of following her resignation, the
sympathy and care,” trained visi- south Philadelphia’s Black com- board voted to allow Wharton and
tors hoped “to help, to advise, to munity prompted Wharton to her newly formed association, the



Whittier Centre, to assume respon-
sibility for all operations of the
Coal Club and the Rainy Day
Society.35

THE WHITTIER CENTRE
EXPANDS SOCIAL
NETWORKS

As a newly formed civic asso-
ciation, the Whittier Centre was
established with the primary aim
of addressing the social and
health needs of Philadelphia’s
growing Black community. These
efforts began in earnest in the fall
of 1912 when Susan Wharton
and several other prominent Phil-
adelphians established the center
at 712 South 18th and 510 South
7th Streets within the heart of activists and medical professionals were able to see so many people Elizabeth Tyler, RN, with members of
the city’s historic Black district. in prominent positions. This strat- because so many club members the Little Mother's Club.
Named after 19th-century poet egy was essential to the sustain- either lived together in the same Source. Whittier Centre, "Annual Report," 1915.
and abolitionist Greenleaf Whit- Reprinted with the permission of the Urban
ability of the Whittier Centre’s houses or lived in close proximity
Archives, Temple University Libraries.
tier, the new association’s mission goals and objectives, which to the center.
was to create practical solutions included “calling on the race to Whittier Centre leaders were
to the social problems plaguing help itself.”39 Beyond this aim, the especially concerned with exces-
the Black community.36 Wharton center’s Black leaders, as mem- sive TB death rates in the Black
served as the Whittier Centre’s bers of the targeted community, community. In 1900, the TB
first treasurer. Henry R.M. Landis, served as mediators and cultural mortality rate among Philadel-
a prominent physician associated brokers between the Whittier phia’s Whites was 197.3 per
with the Henry Phipps Institute, Centre and the communities it 100 000; among Blacks, the rate
served as the centre’s first presi- was intended to serve. was 447.0 per 100 000.43 In
dent.37 The rest of the board of The Whittier Centre’s early 1910, TB deaths among Blacks
directors consisted of five physi- programs were directed toward were 57% higher than among the
cians, one member of the clergy, the active members belonging to city’s native-born Whites and
and five female volunteers. the Coal Club and Rainy Day 44% higher than among the city’s
A group of 18 individuals Society and to individuals living foreign-born Whites.44 Despite
made up the Whittier Centre’s in the squalid alleyways around excessive illness rates, Blacks had
advisory board. Henry Minton, a the city.40 During its first year, limited treatment options. Local
well-known Black physician, was the Whittier Centre continued hospitals and private sanitariums
added to the advisory board in the tradition of home visits to often placed restrictions on admis-
1915. Booker T. Washington Jr, club members, making 42 642 sions of Black patients.45 Adding
son of the famous Black educator visits in 1912 and 1913.41 Whit- to the problem of limited health
and author, joined the Whittier tier Centre visitors were viewed care was low Black patient utiliza-
Centre as executive secretary in as neighbors who were trained tion of those services that were
1919 to assist the organization in available. When TB beds were
[to] get behind the scenes to de-
addressing the housing concerns termine not only the external available, some Blacks refused to
of Black community residents.38 facts but conditions that make leave the comforts of home
for physical and moral deterio-
The Whittier Centre’s racially because they feared the treatment
ration.42
integrated governance structure they would receive from strang-
exemplified the organization’s Visitors frequently provided ers.46 One TB health official
commitment to placing Black services to entire families. They noted that



[Black residents] did not avail autopsy in the event that the the care of Black patients at the
themselves of the benefits of
patient should die while on the dispensary.55 In the Phipps Insti-
dispensaries, or if they did,
made but a few visits, often but ward.53 Although this policy tute’s first year of working with
one, and then ceased coming.47 undoubtedly was intended to the Whittier Centre, the number
ensure the advance of scientific of Black patients visiting the
Aware of the threat of TB, the inquiry, it did little to boost the clinic was twelve times higher
Whittier Centre executive com- confidence of Black community than in the previous 11 years
mittee met on May 14, 1913, to members, who were likely suspi- combined. By 1921, nearly 30%
discuss the merits of hiring a cious of such agreements. of all new Phipps patients came
Black nurse to investigate possi- Thus, despite the overall suc- from the Black community.
ble cases of TB among its Coal cess of the Phipps Institute in its Tyler, Johnson, and Minton
Club and Rainy Day Society early years, the numbers of Black were tireless in their efforts to
members.48 During the meeting, patients at the institute remained improve health in the Black com-
TB expert and Whittier Centre flat. In contrast with the Phipps munity. They organized health
president Landis explained the Institute, the Whittier Centre had lectures in local churches, and
advantage of hiring a Black substantive, long-standing rela- the Whittier Centre established a
nurse: “to really get behind the tionships with Black residents prenatal clinic, well-baby clinics,
scenes requires a visitor within resulting from years of work in and a home supervision service.
the race.”49 This nurse would the community, and the board By 1921, the center’s staff of
“visit Black families in the home was betting that more Blacks Black clinicians, then known as
and subsequently gain their con- would avail themselves of TB the Negro Health Bureau, had
fidence” and would more easily care if more Black nursing and grown from one nurse to 10
dispel any fears or superstitions medical staff were available. To graduate nurses and from one
individuals held regarding ill- that end, Tyler’s job involved physician to 12.56 However, the
ness.50 At this meeting, the Whit- going into the Black community, success of the Whittier Centre’s
tier Centre agreed to provide finding residents suspected of health initiatives did not hinge
the salary to hire its first Black having TB, and referring them to simply on the introduction of
nurse.51 the Phipps clinic for treatment. Black clinicians. The center’s
On February 1, 1914, Elizabeth Tyler’s early months at her new accomplishments were the direct
Tyler, a graduate of Freedman’s post began with home visits to results of collective efforts under-
Hospital Training School in Wash- the nearly 1000 members of the taken by Black community
ington, DC, began providing TB Coal Club and Rainy Day Society. members, social reformers, and
nursing services to Black residents In a report summarizing the work health professionals that ulti-
of south Philadelphia, working of her first year, Tyler noted a mately led to the development
under the auspices of the Henry tremendous voluntary response of a collaborative model of com-
Phipps Institute; her salary was to her nursing visits and her munity health care many
paid for by the Whittier Centre. advice to visit the TB health decades later.
The Phipps Institute was a world- clinic. She noted,
renowned TB treatment and HEALTH PROMOTION IN
it is gratifying to know that the
research facility founded in 1903 number of colored people at- BLACK COMMUNITIES
by Dr. Lawrence Flick. From its tending the Phipps Institute has TODAY
inception, the Phipps Institute been so greatly increased as a
direct result of these house-to-
offered comprehensive inpatient house investigations.54 Notwithstanding the successes
and outpatient treatment of TB.52 of community mobilization and
Despite its close proximity to the Her efforts were so effective health initiatives launched by civic
Black community, the Phipps that within six months of her associations in the early 20th cen-
Institute had not been able to hire, the Phipps Institute hired tury, translating these historic
establish a rapport with Black another Black nurse, Cora John- achievements into the context of
residents. This may have been son. Later that same year, Minton our 21st-century public health
partly caused by its policy requir- (the Black physician who was challenges presents its own set of
ing the nearest relative of patients also a member of the Whittier difficulties. Today many urban
admitted to the inpatient wards to Centre advisory board) joined the communities are racially and eco-
give written permission for an Phipps Institute staff to oversee nomically less diverse than they



“
used to be, and residents are gen- serve as a valuable way to address
erally less apt to have a mutual the social determinants of health As members of civic associations, Blacks
sense of shared responsibility among targeted populations. This were more than mere silent partners in
toward one another, which limits lesson can be generalized to many
need of health and social reform; they were
the spirit of cooperative efforts so different communities throughout
evident among Black club mem- the country, not just racial or eth- crucial to the development of public health
bers a century ago. Still, despite nic minorities. initiatives, and their active participation
the dissimilarities between time Another key strength of the
was of paramount importance to the

”
periods, we can learn from several civic associations discussed here
key lessons embedded in the his- was their ability to forge social initiatives’ success.
tory of civic association commu- bonds between diverse racial and
nity health initiatives. class groups. Indeed, the success
First, civic associations of the of the health initiatives, particu- of public health initiatives, and
early 20th century, such as the larly the Phipps campaign, hinged their active participation was of
Starr Centre and the Whittier on the ability of civic association paramount importance to the
Centre, were in the vanguard of organizers to first build trust initiatives’ success. This focus on
multiple movements, focused among neighborhood residents capacity building, increasing
simultaneously on building a and form relationships with them. social capital, and investing in
community health infrastructure The introduction of Black clini- developing community leaders
while also addressing a housing cians aided in this endeavor, but was most notable in the gover-
shortage and income deprivation. assigning the success of the Whit- nance and organizational struc-
Unlike the disease-focused mod- tier Centre’s anti-TB campaign ture of the Whittier Centre, but
els of community health, which merely to the inclusion of racially such a focus can also be seen
grew in popularity over the concordant health providers today in community-based partic-
remainder of the 20th century, would be a disservice to White ipatory research, which aims to
the associations discussed here philanthropists such as Starr and empower community members
achieved success by identifying Wharton who each spent to own study questions, research
people’s material needs first. This decades working among Black methods, and data collected about
focus on the comprehensive community residents addressing themselves.58 Like its predeces-
wants of the community was community concerns and building sors, community-based participa-
based on the recognition that the rapport.57 It was this time com- tory research strives to enhance
determinants of public health are mitment and active, persistent and increase health awareness
structural and are largely related engagement with Black club and health activism among mem-
to poverty and the environment. members that served as the pre- bers of minority communities.
Thus, any effort to address more cursor to Tyler’s work among We now face altogether differ-
abstract concerns, such as disease Black Philadelphians. This assem- ent public health concerns from
prevention, first had to address blage of equally invested part- those prevalent a century ago,
more immediate needs, such as ners—lay residents, health but health inequities still persist.
food and coal. Once these areas workers, and philanthropists— Clinicians, researchers, and com-
of concerns were addressed, then crossed racial and economic lines. munity health activists can draw
interventions addressing infectious Alhough divergent in origin, they on historical precedents to address
disease and other maladies fol- remained unified in purpose. contemporary public health con-
lowed with a greater degree of A critical strength of the civic cerns by identifying community
success. associations discussed here was strengths, leveraging social net-
What history demonstrates in their provision of a platform for works, mobilizing community
this instance is the importance of community residents to help members, training community
beginning with an understanding themselves through leadership leaders, and building partnerships
of the base determinants of well- opportunities and cooperative with indigenous community
being. A more specific focus on engagement. As members of civic organizations. Many Black and
health should wait until this pre- associations, Blacks were more minority communities continue
liminary step is accomplished. His- than mere silent partners in need to view civic associations, such as
tory also demonstrates how of health and social reform; they churches and social organizations,
building community networks can were crucial to the development as valuable resources for health



information and as places in 2. The poor health of Blacks during the of Pennsylvania Press, 1979), 7–32.
early 20th century captured the atten- See also: DuBois, The Philadelphia
which to address pressing social
tion of a wide range of scholars and Negro, 357; Michael B. Katz, In the
concerns. Thus, it is important for public health commentators. See: W.E.B. Shadow of the Poorhouse: A Social His-
contemporary public health work- Dubois, “The Health of Negroes,” in The tory of Welfare in America (New York,
Philadelphia Negro: A Social Study (Phil- NY: Basic Books, 1986).
ers to integrate their health efforts
adelphia: University of Pennsylvania 9. “Starr Centre Historical Information
within these institutions to Press, 1899), 147–63; C.R. Grandy, Sheet,” p. 2, Starr Centre Collection,
advance mutually agreed-upon “The Control of Tuberculosis in the Barbara Bates Center for the Study of
Negro,” Virginia Medical Monthly 54
health goals. Civic engagement the History of Nursing, University of
(1927): 566–71; C. Guild, “A Five Year Pennsylvania. See also: V.P. Franklin,
between community members Study of Tuberculosis among Negroes,” “Operation Street Corner: The Wharton
and civic associations is still piv- Journal of Negro Education July (1937): Centre and the Juvenile Gang Problem
548–52; Henry R.M. Landis, A Report
otal to the success of community in Philadelphia, 1945–1958,” in W.E.B.
of the Tuberculosis Problem and the Negro DuBois, Race and the City: The Philadel-
health initiatives. (Philadelphia: Henry Phipps Institute, phia Negro and Its Legacy, ed. Michael
1923), 10a, table 7. Katz and Thomas J. Sugrue (Philadel-
3. Suellen M. Hoy, “‘Municipal House- phia: University of Pennsylvania Press,
About the Author keeping’: The Role of Women in Im- 2000), 97; E.J.G. Beardsley, “The Value
Margo Brooks Carthon is with the School of the Intelligent Direction of the Sick
proving Urban Sanitation Practices,
of Nursing, University of Pennsylvania, Poor - A Story of The Starr Centre As-
1880–1917,” in Population and Reform
Philadelphia. sociation of Philadelphia,” Therapeutic
in American Cities, 1870–1930, ed.
Correspondence should be sent to Gazette June (1911): 2.
M.V. Melosi (Austin: University of Texas
Margo Brooks Carthon, 418 Curie Blvd,
Press, 1980), 173–98. 10. Beardsley, “The Value of the Intelli-
Philadelphia, PA 19104-6096 (e-mail:
jmbrooks@nursing.upenn.edu). Reprints 4. Susan L. Smith, Sick and Tired of gent Direction of the Sick Poor,” 2;
can be ordered at http://www.ajph.org by Being Sick and Tired: Black Women’s “Starr Centre Historical Information
clicking the “Reprints/Eprints” link. Health Activism in America, 1890–1950 Sheet,” Starr Centre Collection, p. 2.
This article was accepted January 10, (Philadelphia: University of Pennsylva- 11. Starr Centre Association, “Charter
2011. nia Press, 1995), 32. See also: Darlene and Bylaws of the Starr Centre Associa-
Clark Hine and Kathleen Thompson, A tion,” June 2, 1905, p. 4, Starr Centre
Shining Thread of Hope: The History of Collection, box 9, folder 105.
Acknowledgments Black Women in America (New York:
12. Beardsley, “The Value of the Intelli-
Margo Brooks Carthon is supported by Broadway Books, 1998).
gent Direction of the Sick Poor, ” 1–11.
the National Institute for Nursing Re- 5. The formation of Black churches and
search (grant K01NR012006). This re- 13. Starr Centre, “A Few Facts About
other social and benevolent societies
search was also supported by a Ruth L. the Starr Centre,” 1905, Starr Centre
represented an important antidote to
Kirschstein NRSA Doctoral Fellowship Collection, MC 9, series IV, folder 105;
anti-Black sentiment, social isolation,
from the Agency for Healthcare Re- Starr Centre Association, “Milk and
and prejudice. Philadelphia’s Free Afri-
search and Quality (grant F-31 Medical Department,” 1911, Starr Cen-
can Society, established in 1787 by
HS01029-02). tre Collection, MC 9, series IV, folder
Richard Allen and Absolam Jones, is an
Special thanks to Julie Fairman, PhD, 104.
example of such an organization. For
Joan Lynaugh, PhD, Barbara Savage, further reading on benevolent societies, 14. Starr Centre Association, untitled
PhD, Robin Stevens, PhD, Bridgette see Hine and Thompson, A Shining pamphlet, 1907, Starr Centre Collec-
Brawner, PhD, Jillian Baker, PhD, Jasmine Thread of Hope, 39. tion, box 9, folder 105.
McDonald, PhD, and Melissa Gomes, PhD,
6. US Bureau of the Census, Negro Pop- 15. Susan P. Wharton, “Starr Centre
for their support and feedback on ear-
ulation in the United States, 1790–1915 First Annual Report,” 1903, Starr Cen-
lier drafts of this article.
(Washington, DC: Government Printing tre Collection.
Office, 1968), 350–51; Allen F. Davis, 16. Starr Centre Association, untitled
The Peoples of Philadelphia: A History of pamphlet, 1907, Starr Centre Collec-
Endnotes
Ethnic Groups and Lower Class Life, tion, box 9, folder 105.
1. The enduring pattern of health ineq- 1790–1940 (Philadelphia: Temple Uni-
uities among Black communities has 17. Starr Centre Association, board of
versity Press, 1973). For more on the
been captured in the work of a number directors meeting minutes, July 13,
migration patterns of Blacks entering
of historians from the 19th and early 1911, Starr Centre Collection.
Philadelphia, see: Armstrong Associa-
20th centuries. For more on the history tion, “Report of Negro Population and 18. It is important to note that intrara-
of illness among Blacks, see: David Industries in Philadelphia,” 1927, mim- cial tensions were not uncommon
McBride, From TB to AIDS: Epidemics eograph, Armstrong Association Papers, among Black civic association members
among Urban Blacks Since 1900 (New Urban Archives, Temple University Li- because of differences in class standing
York: University of New York Press, braries. and religious affiliation. In her historical
1989); Keith Wailoo, Dying While in the account of health promotion in the rural
City (Chapel Hill: University of North 7. Sadie T. Mossell, “The Standard of south, historian Susan Smith uncovers
Carolina Press, 2001); Vanessa Gamble, Living among One Hundred Negro Mi- evidence of such tensions in her exami-
Germs Have No Color Lines: Blacks and grant Families in Philadelphia,” Annals nation of the Tuskegee Woman’s Club.
American Medicine 1900–1940 (New of the American Academy of Political and The club women were all Black, edu-
York: Garland Publishing, 1989); Sam- Social Science 98 (1921): 174–75. cated, and well off, and they believed it
uel Kelton Roberts Jr, Infectious Fear: 8. Franklin VP. The Education of Black their “calling” to improve the physical,
Politics, Disease, and the Health Effects of Philadelphia: The Social and Educational spiritual, moral, and educational lives of
Segregation (Chapel Hill: University of History of a Minority Community, rural Blacks. Middle-class Black women
North Carolina Press, 2001). 1900–1950 (Philadelphia: University asserted that their class, as well as their



gender, made them uniquely fit to bring 35. It remains a mystery why, after so the Whittier Centre. Whittier Centre, 1926; “Dedication of the Phipps Insti-
about the salvation of the race. These many years of work with the Black “Annual Report,” 1915, p. 4, Wharton tute,” news clipping, December 1909.
assumptions often led to tension be- community, the Starr Centre Associa- Center Collection. All items in Information Files Collection,
tween middle-class and poor club mem- tion jettisoned those relationships and 41. Whittier Centre, “Annual Report,” UPF 8.51, University of Pennsylvania
bers. See: Smith, Sick and Tired of Being handed them to Wharton. I suspect that 1917, pp. 7–8, Wharton Center Collec- Archives. See also: Bates, Bargaining for
Sick and Tired, 18–21. the needs of the community were out- tion. Life.
pacing the Starr Centre’s capacity. Also, 53. Bates, Bargaining for Life, 108.
19. Susan P. Wharton, “Negro Branch of 42. Henry R.M. Landis, Whittier Centre,
the Black community’s growth was so
the Starr Centre,” 1909, Starr Centre “Annual Report,” 1916, p. 2, Wharton 54. Whittier Centre, “Annual Report,”
tremendous that the Starr Centre may
Collection. Center Collection. 1915, pp. 4–5, Housing Association of
have been increasingly regarded as an
20. Starr Centre Association, “Annual “organization for Blacks,” which might 43. First annual message of John Rey- the Delaware Valley (HADV) Collection,
Report,” 1911, p. 7, Starr Centre Collec- have reduced its viability for other burn, 1908, p. 96, City Archives, Phila- Urban Archives, Temple University Li-
tion. needy sections of the community. These delphia. braries.
21. Starr Centre Association, board of thoughts, however, are purely conjec- 55. Whittier Centre, “Annual Report,”
44. Bureau of Health, “Annual Report,”
directors meeting minutes, July 13, ture; the historical record is silent about 1916, p. 2, HADV Collection.
1918, City Archives, Philadelphia.
1911, Starr Centre Collection. the real motives behind the center’s re-
45. Mossell, A Study of the Negro Tuber- 56. Whittier Centre, “Annual Report,”
sistance to expansion of services tar-
22. Starr Centre Association, “Annual culosis Problem in Philadelphia, 18. 1924, p. 13, HADV Collection. It is
geted toward Blacks.
Report,” 1911, p. 10, Starr Centre Col- worth noting that the local health inter-
36. Whittier Centre, “Annual Report,” 46. Barbara Bates, “P.S. I Am . . . Col-
lection. ventions of the Whittier Centre and the
1914, Wharton Center Collection. One ored,” in Bargaining for Life: A Social
Phipps Institute were not isolated initia-
23. Wharton, “Negro Branch of the History of Tuberculosis, 1876–1938
of the Whittier Centre’s earliest collabo- tives to improve health in Black com-
Starr Centre,” p. 16, Starr Centre Collec- (Philadelphia: University of Pennsylva-
rations was with the Philadelphia Hous- munities; they in fact ran parallel to na-
tion. nia Press, 1992), 288–310.
ing Commission, a privately funded as- tional efforts such as National Negro
24. Sadie T. Mossell, “A Study of the sociation working toward housing 47. Landis, A Report of the Tuberculosis Health Week, which Booker T. Wash-
Negro Tuberculosis Problem in Philadel- reform. In 1914 the commission con- Problem and the Negro, 1. See also: ington launched in 1915 to increase
phia,” 1923, p. 18, Starr Centre Collec- ducted a study on the housing condi- Henry Phipps Institute, “Fifth Annual health awareness among Blacks.
tion. tions of the city’s Black residents, and Report,” 1909, pp. 10, 19, Philadelphia
57. The Starr Centre and Whittier Cen-
25. Whittier Centre, “Annual Report,” the Whittier Centre offered the services College of Physicians. In his annual re-
tre represent just two examples of inter-
1917, p. 7, Wharton Center Collection, of its visiting staff to collect data for the port to the Phipps Institute, Lawrence
racial cooperatives run collaboratively
URB 30, series I, box 1, Urban Ar- study. Data collectors visited 1158 Flick, head of the institute’s Clinical and
by Blacks and Whites. Other historical
chives, Temple University Libraries. homes, where 4891 Blacks lived. The Sociological Departments, noted the low
examples reveal the importance of
results of this study were published in percentage of Blacks treated at the insti-
26. Wharton, “Negro Branch of the building trust and improving communi-
the Whittier Centre’s “Annual Report” tute since its inception. Blacks repre-
Starr Centre,” 1909, p. 4, Starr Centre cation across race and class lines to ad-
(1914) and summarized by Bernard J. sented 6.63% of the total percentage of
Collection. dress health and social inequities. In
Newman, executive secretary of the Phipps patients during its first year
Chicago, for instance, White settlement
27. Ibid. Philadelphia Housing Commission. (1904), 5.65% in 1905, 5.96% in
workers joined Black reformers in
1906, 9.83% in 1907, and 7.68% in
28. Ibid. 37. Henry R.M. Landis was a key figure founding the Frederick Douglass Center,
1908. He further reported that Blacks
during the Phipps Institute’s first three an interracial settlement that cam-
29. Starr Centre Association, “Annual held nearly the highest rates of single
decades of operation. Born in 1872, paigned for equal treatment for Blacks.
Report,” 1911, p. 7, Starr Centre Collec- visits with no return follow-up, com-
Landis was a leading clinician and re- For further reading on interracial coali-
tion. pared with other racial/ethnic groups.
searcher in the field of TB and was per- tions in Chicago, see: Steven J. Diner,
30. Starr Centre Association, “Annual Lawrence Flick, “Clinical and Sociologi-
sonally chosen by renowned TB special- “Chicago Social Workers and Blacks in
Report,” 1909, pp. 4–5, Starr Centre cal Report,” 1909, Phipps Institute Re-
ist Lawrence Flick to work at the the Progressive Era,” Social Service Re-
Collection. ports, Van Pelt Library, University of
institute. After graduating with an AB view 44, no. 4 (1970): 393–410. Inter-
Pennsylvania.
31. Ibid. from Amherst College in 1894 and racial cooperation also emerged through
completing medical school at Jefferson 48. Whittier Centre, executive board evangelical and religious efforts, such as
32. For further reading on interracial Medical College in Philadelphia in meeting minutes, 1913, p. 1, Wharton the Young Women’s Christian Associa-
and class tensions, see: Gerda Lerner, 1897, Landis embarked upon a career Center Collection. tion (YWCA). The YWCA experienced
“Early Community Work of Black Club specializing in the treatment of TB. both interracial discord and coopera-
Women,” Journal of Negro History 59, 49. Ibid.
Landis was renowned both nationally tion, but it remains an illustrative exam-
no. 2 (1974): 158–97. and locally, serving as the founder of 50. Ibid. ple of the triumphs and complexities of
33. Starr Centre Association, board of the National Tuberculosis Association and 51. Tyler’s work as a public health building community networks. For fur-
directors meeting minutes, May 28, presiding over the Pennsylvania Tuber- nurse is consistent with the efforts of ther readings on the history of the
1912, p. 1, Starr Centre Collection. culosis Society from 1928 to 1932. her peers in the profession during this YWCA, see: Nancy Marie Robertson,
Wharton’s full plan for expanding ser- While at Phipps he functioned as an as- period. For further reading on Black “Kindness or Justice? Women’s Associa-
vices for Black club members included sistant professor of medicine and direc- public health nurses, see: Marie O. Pitts tions and the Politics of Race and His-
the establishment of a separate neigh- tor of the Clinical and Sociological De- Mosely, “Satisfied to Carry the Bag: tory,” in Private Action and the Public
borhood house for Blacks, with the ad- partments, and he served as visiting Three Black Community Health Nurses; Good, ed. Walter W. Powell and Elisabeth
dition of a head social worker to coordi- physician to the Commonwealth of Contributions to Health Care Reform, Stephanie Clemens (New Haven, CT:
nate services. The board considered Pennsylvania’s White Haven Sanato- 1900–1937,” Nursing History Review 4 Yale University Press, 1998), 193–96.
whether it would continue its work with rium. He was also connected clinically (1996): 65–82. Also, on Black hospital 58. Nina Wallerstein and Bonnie Duran,
Blacks should Wharton depart; they de- with Philadelphia General Hospital until nurses, see: Darlene Clark Hines, Black “Community-Based Participatory Re-
cided instead to allow Wharton to as- 1909. Women In White: Racial Conflict and search Contributions to Intervention Re-
sume responsibility for all services pro- Cooperation in the Nursing Profession, search: The Intersection of Science and
38. Whittier Centre, “Annual Report,”
vided to the Starr Centre’s Black club 1890–1950 (Bloomington: Indiana Uni- Practice to Improve Health Equity,”
1914, Wharton Center Collection.
members. versity Press, 1989). American Journal of Public Health 100,
39. Ibid. no. S1 (2010): S40–S46.
34. Starr Centre Association, board of 52. Lawrence Flick, “Report of the
directors meeting minutes, June 11, 40. By 1914, half of the former respon- Henry Phipps Institute,” 1904, pp. 4–5;
1912, p. 2, Starr Centre Collection. sibilities of the Starr Centre rested with “The Phipps Gift,” Gazette, March 5,


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