Health and Nutrition

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The Great Depression was both the cause of increased suffering and a decline in the health status of millions of Americans, and, through the New Deal, the occasion for some of the most innovative and substantive federal reforms in American health care. Ironically, while some historically disadvantaged groups, especially rural Americans, gained greater access to health care than they had had prior to the Depression, this period also marked the beginning of one of the worst scandals in American public health and medical ethics.

The massive unemployment and wage cuts of the early years of the Depression had a conspicuous negative effect on the ability of workers and farmers to take care of their medical needs and assure adequate nutrition for their families. As a result there was a marked decline in the quantity and quality of health care for those in the lower income brackets, a consequent increase in doctors having to provide free consultations, and an increase in free care in clinics and hospitals. Rural areas, especially in the South, were particularly hard hit, with about half of the South's population not capable of paying for medical care. Cities slashed their appropriations for health and sanitation, and some used fear of contagion to justify violence against migrants and the dispossessed who gathered in Hoovervilles within their borders.

Some studies suggest that those on relief were almost twice as likely to endure a chronic disease as those who made $3,000 a year (a moderate income), but other studies suggested that those who had fallen from middle-class or strong working-class positions suffered the most because of their unwillingness to take advantage of food and relief programs. One study found, for instance, that in several major cities undernourishment increased noticeably among school children of families who had undergone a dramatic decline in their economic fortunes.

Out of these conditions, cities and states started to provide food and medical care as early as 1930, but these efforts were soon overwhelmed by the massive need, and in 1933 the New Deal's Federal Emergency Relief Administration intervened to provide direct medical care for the indigent. Subsequent programs provided support for states and cities to build and improve hospitals, sanatoria, and medical clinics; hundreds of such buildings were constructed during the New Deal years. The Social Security Act of 1935 appropriated funds for the expansion of institutions for children with various disabilities and the development of health education all over the country.

Probably the most important New Deal health programs were the Resettlement Administration's (1935–1937) efforts to provide medical care for the poor in the South, and later the programs of the Farm Security Administration (FSA, 1937–1946), which, as Michael Grey's New Deal Medicine documents, made "medical care delivery a cardinal feature of the New Deal's rural rehabilitation program." Over the course of the next six years, the FSA established medical care cooperatives in one-third of the rural counties in the United States, concentrated in the South and the West. The cooperatives were open to all FSA borrowers and their families and covered ordinary medical care, obstetrical care, emergency surgery, some hospitalizations, and ordinary drugs. FSA leaders involved county and state medical societies in the planning process, ensuring that participation by clients and doctors was voluntary, and allowing a free choice of doctors. While these medical cooperatives were critical to the melioration of rural health care, the FSA's migrant health program was probably the most innovative and pathbreaking New Deal health initiative. Emphasizing health education and prevention, as well as treatment, the migrant health program depended upon nurses (all women) and stretched professional boundaries to give them widespread clinical and administrative responsibility.

The tumultuous economic, political, and social environment of the New Deal was also the occasion for major initiatives in occupational health. Workers who were thrown out of work in what were known as the dusty trades (jobs in mining, construction, foundries, steel mills, etc. that exposed workers to a wide variety of poisonous dusts) argued that industry bore the responsibility for their predicament. They contended that their plight was not the result of individual failing or bad luck, but, rather, was due to the inadequate protection offered them by their employers, and they turned to the courts for redress. Thousands of workers in the dusty trades, laid off during the Depression, brought lawsuits against employers seeking damages for exposure to silica. This led to a broad liability crisis threatening the closing of industrial plants and a vast economic loss. For the first time, the problem of occupational disease moved out of the domain of professionals and a few labor unions into the arenas of politics, public policy, and popular culture, with the result that silicosis (a chronic occupational lung disease caused by the inhalation of finely ground sand) came to be called the "king of occupational disease." Before the Depression ended, novels, movies, national magazine exposés, and intense media attention forced the issue of industrially caused chronic disease, especially silicosis, onto the national agenda.

The financial crisis was addressed, however inadequately, through the eventual inclusion of silicosis in the various state compensation systems. But the political crisis remained as long as the issue was in the public arena, and during the mid-1930s came the revelation that perhaps as many as 1,500 workers had been killed by exposure to silica dust while working on a tunnel project in Gauley Bridge, West Virginia, an incident that Martin Cherniack describes in The Hawk's Nest Incident as "America's worst industrial disaster." Newspapers and weeklies all over the country made silicosis a national scandal, telling the story of how workers had died of acute silicosis and other respiratory diseases while constructing this tunnel for the Union Carbide Company. The two thousand workers were mostly southern rural blacks drawn to the job and away from their families farther south by the promise of steady pay during the Depression. They had been ordered to drill through a mountain that was composed of nearly pure silica, even then known as a substance that destroyed lung tissue, incapacitating and killing its victims. The fact that the workers were primarily poor, black migrants far away from their loved ones led management to believe that they could cover up the deaths.

As a result of the publicity and subsequent congressional hearings, Secretary of Labor Frances Perkins sponsored a conference in 1936 that brought together representatives of government, labor, and industry to help resolve the silicosis crisis. The importance of a national approach that gave workers a voice was represented institutionally through the creation of the Division of Labor Standards, which for the first time focused the attention of the federal government on occupational diseases and the need for engineering reforms to protect the work force. Indeed, under the Social Security Act, the Public U.S. Health Service provided funds to state departments of health for the establishment of industrial hygiene divisions.

The Public Health Service also initiated a variety of programs to improve sanitation and health, especially in rural areas, but it was one project that it began in 1932 and continued for forty years that would overshadow the constructive work that the Public Health Service did during the Depression. In 1972 it was revealed that the Public Health Service had been engaged in a study of the effects of untreated syphilis on black men in Macon County, Alabama. The study involved 399 men who had syphilis, and 201 more who were disease-free and used as controls. Macon County was one of the poorest counties in the South, with an epidemic of chronic malnutrition and other serious health problems. Rather than deal with the widespread syphilis among its residents, the Public Health Service chose to study what happened to these men if their syphilis was left untreated. According to Jim Jones's Bad Blood, the Tuskegee Study of Untreated Syphilis in the Negro Male, as it was called, was the longest-running non-therapeutic experiment on human beings in medical history. The Tuskegee study is probably the best-known health-related activity of the Depression era, and it casts a shadow over the government's many positive accomplishments in health and nutrition during the period.



Beardsley, Edward H. A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South. 1987.

Cherniack, Martin. The Hawk's Nest Incident: America's Worst Industrial Disaster. 1986.

Collins, Selwyn D., et al. Research Memorandum on Social Aspects of Health in the Depression. 1937.

Fee, Elizabeth. "The Pleasures and Perils of Prophetic Advocacy: Socialized Medicine and the Politics of American Medical Reform." In Making Medical History: The Life and Times of Henry E. Sigerist, edited by Elizabeth Fee and Theodore M. Brown. 1997.

Grey, Michael. New Deal Medicine: The Rural Health Programs of the Farm Security Administration. 1999.

Jones, Jim. Bad Blood: The Tuskegee Syphilis Experiment, rev. edition. 1993.

Markowitz, Gerald, and David Rosner. Slaves of the Depression: Workers' Letters About Life on the Job. 1987

Reverby, Susan. Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. 2000.

Rosner, David, and Gerald Markowitz. Deadly Dust: Silicosis and the Politics of Occupational Disease in Twentieth-Century America. 1991.

Wailoo, Keith. Drawing Blood: Technology and Disease Identity in Twentieth-Century America. 1997.

Gerald Markowitz

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