During the first decades of the twentieth century, various cities in the United States began to employ new public health techniques in the administration of their public health departments. These techniques not only included introducing new scientific advances in epidemiology, diagnostics, and disease control, but also involved incorporating various social programs within the health department, most notably those associated with public health nursing. However, African Americans received few of the benefits derived from the move toward improved public health, and that the benefits they did receive were confined to those programs administered by the city's public health nurses.
In the early twentieth century, when the United States embarked on its campaign to modernize its public health department, national standards of public health practice were being developed in the North. Confounding the easy importation of northern ideas of public health directly into southern practice, however, was the fact that the urban population of African Americans, a group that routinely experienced high rates of mortality and morbidity, was relatively high, and American racism existed in a very specific and institutionalized fashion. One of the consequences of southern racial attitudes was that, in southern cities, African Americans did not constitute a primary constituency for public health intervention. This was based, in part, on strongly held beliefs that African Americans were largely responsible for creating their own particular health problems, either as the result of behavior or inheritance. As a result, improvements in black health were largely incidental to efforts to make southern cities healthier for their white citizens. With few exceptions, all of the public health initiatives tended to be undertaken with little regard for the particular health problems of the city's black population. Only in those programs administered by the city's public health nurses did African Americans receive health care services in proportion to their needs................
