Community and Public Health Partnerships in Diverse Settings

Public Health Partnerships in Diverse Settings

Who was the population of interest at that moment in time? In the article by Carthon, the African-American population in Philadelphia was in focus. At the turn of the last century, 1900, the statistics clearly showed that a much higher percentage of African-Americans ("blacks" is used in the references) were dying due to tuberculosis (TB) than Caucasians ("whites") (Carthon, 2011, 32). In fact the statistics showed that about 447 blacks per 100,000 were dying (from TB) at that time compared with just 197.3 whites per 100,000, Carthon explains.

What was the environmental context within which the population lived at that time? Why were blacks more susceptible to TV than whites in the early 20th century? Carthon suggests that blacks tended to have jobs that had a "high exposure to dust, such as marble, stone, plaster, wood, and textile work." Clearly the black worker exposed to these elements was more likely to be a candidate for TB than teachers, bookkeepers and others in the middle class whose employment did not include unhealthy environments.

What was the main problem/focus concerning this population at that moment in time? Making the problem more severe was the fact that blacks (for a number of reasons) did not feel comfortable traveling to sanitariums or entering hospitals. Why? For a "…sick man traveling without civil rights," not sure where he would stay, having a weakened body, fearing "mistreatment" and other unknowns, he preferred in many instances to "…remain at home with his family and trust God for the rest" (Carthon, 35). On page 36 Carthon explains that when the University of Pennsylvania took over the Henry Phipps Institute (HPI), improving the facilities considerably, it was perhaps expected that more blacks (with TB) would avail themselves of these services, but that didn't happen, Carthon explains. Blacks were "…more disposed to help themselves," the author continues. In 1922 there were 427 black patients with TB in the HPI; the number of white patients was 1,541, demonstrating that whites were far more willing to seek treatment than blacks (Carthon, 36). This unbalanced number of patients held true despite the fact that blacks were "more prone to tuberculosis" than white people (Carthon, 36).

After the Whittier Centre funded a black nurse (Elizabeth Tyler) to reach out to the black community, the number of blacks visiting HPI increased "rapidly," which was a positive approach to getting more blacks with TB into proper care.

How were the stages (as presented in the CCAT, formation, maintenance and institutionalization) exemplified between 1900 and 1930? The Community Coalition Action Theory is based on cooperation through a coming together of several groups, all of which are seeking solutions to community problems. "…Holistic approaches can deal successfully with problems where fragmented approaches cannot" (CCAT, 238). In the case of blacks and TB, the resources needed to help lower the death rates for TB sufferers were greatly enhanced through the joint efforts of HPI, the Whittier Centre, and the University of Pennsylvania.

The first stage begins before the building of the coalition can be identified; several civic groups gave consideration to "…alternative methods to prevent the disease and attract black patients to clinics," Carthon writes (30). The CCAT points to the "community context" in which "specific factors" enhance (or "inhibit") the development of a coalition; the community context in this case was the terrible toll that TB was taking on the black community. The Henry Phipps Institute was launched in 1903, which was apparently first to respond to the great need. However, blacks did not participate with HPI to any significant degree between 1903 and 1914; they did not have a "history of collaboration" and they didn't have "social capital" -- nor did they trust the medical community (CCAT, but after HPI hired a black nurse, more blacks were willing to participate.

The second stage was the hiring of a black nurse because there was another community organization willing to pay her salary -- that organization was the Whittier Centre, which was founded in 1912 and a group that had a "mediating function" between the black community and the HPI (Carthon, 31).

The third stage came about when the Whittier Centre collaborated with two "…predominately black benevolent societies, the Co-operative Coal Club and the Rainy Day Society," both with their roots that go back to the nineteenth century (Carthon, 31). Thus the coalition membership grew and the "core group of people" in the coalition represented a variety of social interest and advocacy organizations (CCAT).

How was the CCAT exemplified? Who were the members of the coalition? The Whittier Centre, the University of Pennsylvania, the HPI, the Co-operative Coal Club and the Rainy Day Society were part of the coalition. A bit later, the Pennsylvania Society for the Study of Tuberculosis also became part of the coalition as that organization paid part of the salary of Ms. Tyler, and the Pennsylvania Department of Health paid the salary of Dr. Henry Minton, a black physician.

Did the coalition assist the population to have a sense of "ownership" and "trust"? Indeed the coalition did contribute to a better relationship between the medical community and the black community. The Whittier Centre had for years been concerned with justice and equality, so its involvement included building a sense of trust. The collaboration between HPI and the Whittier Centre helped create "…a sense of racial pride among community residents" (Carthon, 45). Having a black nurse and a black doctor gave blacks a sense of ownership they had not previously enjoyed.