Building a Healthy Black Harlem: Health Politics in Harlem, New York, from the Jazz Age to the Great Depression
By Jamie J. Wilson
Amherst, New York, Cambria Press, 2009

In a period of national struggle for a universal, affordable health system, Jamie J. Wilson's new book, Building a Healthy Black Harlem, a story of the fight to improve health conditions and medical care in Harlem in the first few decades of the 20th century is as relevant as ever. In addition to serving as a strong, well-researched historical study of Harlem's African American community to care for one another and to win meaningful resources to service the community, Wilson does well to link those efforts to today's issues.

Wilson opens the book with a careful quantitative study of the health conditions in Harlem in those years. He links those conditions to the economic and political realities as they were impacted by racial discrimination and structural racism. As he notes, "By the late 1920s, de jury and de facto segregation in New York City had created a situation where black Harlem had within its boundaries some of the most densely populated block, many congested and unsafe apartment buildings, and excessively high rents." Both sanitary conditions and the spread of infectious disease presented combined with this background to make Harlem's mortality rates among the highest in the city. In addition, policies of overt discrimination and exclusion in the city's medical centers and hospitals meant that most of Harlem crowded into a single public hospital and a handful of private sanitariums and community clinics.

In the attempt to compensate for this dire situation African Americans turned to what Wilson's describes as "magico-religious" caregivers. Unwilling to dismiss this portion of the health services sector as simply "quacks" as the authorities in the city and the state had done, Wilson argues the hundreds of men and women who worked in this field served a particular cultural need and reflected a commonly held belief in the interrelatedness of "sickness, health, and well-being [that] were situated in and ideological and cultural world." Simply put, "magico-religious practitioners and their Black clients understood the connectedness of their environment and their well-being and sought avenues to improve both in a society in which racism prevented their ready access to either. To this effect, Wilson argues, occult practices and other forms of "quack" medicine may not have been serious medicine but these practitioners south "to help their clients take control of their lives and the healing process."

A statewide political and criminal campaign to outlaw and suppress these practices may have been well intentioned on the part of the newly professionalizing medical field, but little was done in the way of trying to improve the dire health conditions in Harlem that caused such practices to flourish.

Wilson continues the narrative by examining the community movement to win political concessions from the city to hire African American doctors at Harlem Hospital. In fact, Wilson reveals how this fight came at a time when African American voters began to understand the failures of the Republican Party to address their needs and the beginnings of the shift in party loyalty to the Democrats formalized under Roosevelt's New Deal administration in the 1930s. To African American Harlemites the struggle for more Black doctors and nurses meant more than token representation. The goal was increased community control over decision making in the health care field. Some early successes in the fight revealed growing African American power. In a chapter on the impact of the New Deal on health reform in Harlem, Wilson details the fight for increased access to affordable medical care, improved sanitary conditions in housing, access to public housing as an alternative to privately controlled apartment buildings, and improved education, child care, and safe streets and parks that Harlemites linked to the fight to improve the overall health of their community.

This important historical study is a rewarding and quick read. If you are interested in a rare look at the struggle for civil rights as it was linked to the issue of health care this useful little book will likely fill a big hole in your library.