Editor's note: The following is an interview with Jamie J. Wilson, author of Building a Healthy Black Harlem. Listen to the excerpted audio version here.



PA: I wanted to talk to you about your new book, Building a Healthy Black Harlem. In the book you descibe how African American residents of Harlem were facing a particular health care crisis in the early part of the 20th century.



JAMIE WILSON: It was not only that they were dealing with a crisis per se. The title is Building a Healthy Black Harlem, and the focus, for me at least, is on building a healthy community. The question is how did recently arrived migrants and immigrants – immigrants, of course, from the English-speaking Caribbean – go about formulating and creating strategies to ensure that they had a healthy community? Part of that was about housing and part of that was about politics, and in my book I argue that they had to sit down and think about the ways in which they were experiencing compromised health. Along with the wonderful Harlem Renaissance we think of in the 1920s and early 1930s, it is necessary to think about the concrete strategies and ways in which Harlem residents went about figuring out what it means to be healthy and what it means to be a community. So the story really is about a community-building strategy and community-building ideas.



PA: One of the cultural responses in Harlem to this community-building process and the response to compromised health care that you describe is the turn to the popular use of magico-religious practices, the kinds of practices which may not have been the best solutions to this issue, but which, in your view, have a certain kind of significance in themselves. Could you describe that situation?



JAMIE WILSON: At that time the people of Harlem were suffering from tuberculosis in large numbers. From 1923-1927 pulmonary tuberculosis caused 1839 deaths among Harlem residents, or 193 deaths per 100,000 people. If you look at the same period of time in Manhattan, the rate is 150 per 100,000. If you look at some of the causes of sickness, one is you have people who are coming to Harlem from completely different cultural situations. Infant mortality was also at a high rate.



Magico-religious workers are individuals who fuse ideas relating to supernatural controls and phenomena, occult practices and religious beliefs, in order to provide answers and directions to their clientele, and this involves all matters of community life, including, but not limited to, money, love, family, and physical and mental health.



In the African American tradition, and I’m not saying that every single person subscribed to such an idea, there is the notion that there are individuals who possess the ability to tap into the supernatural world in order to help people in their personal development. So the term magico-religious workers is broad. It involves a spectrum of individual creativity, of beliefs, practices and cultural traditions which people draw upon and utilize.



What I am suggesting is that while there were some people who were peddlers of innocuous goods and dubious cures and some people who wanted fast monetary gain, there were also some self-described healers, clairvoyants, fortune-tellers, magicians and spiritualists who did help people deal with their new environment. Here I am talking about a psychosocial approach to Harlem and understanding the residents of Harlem. Because if you are coming from a place like Virginia, or if you are coming from the Bahamas or Jamaica, this is a really new environment for you. So if I can go to a fortune-teller down the street because I’m not feeling well on that particular day, or I don’t think I have control over my existence at that moment, that person can give me some sort of psychosocial care.



Now we all believe in psychiatrists, and when we are not feeling well and we have the blues, we can go to a psychiatrist. What I am arguing is that some of these magico-religious workers provided psychiatric care for people. But during this same period of time in New York City and in the United States, you have the professionalization of American medicine, and the rise of these magico-religious workers essentially is coming under assault. I suggest in the book that there was a criminalization of magico-religious workers, and through this criminalization of magico-religious workers, you had an undermining and an undercutting of some individuals who provided necessary care for a community that had very few or no other health care outlets.



PA: And in the process there is the elimination of what you describe as a kind of psychological/psychiatric cultural system which was in place for immigrants coming to Harlem, but while that’s under assault there is nothing to replace it.



JAMIE WILSON: There was no replacement. And decisions were being made about the health care of Black individuals in Harlem in the 1920s and 30s by people who didn’t even belong to the community, who didn't really understand what the community was about, or how some of the people in the community worked. For example, in the 1930s the health commissioner of New York City said that central Harlem, the geography or political space I am writing about, required 62 public health nurses, but they only received 29 from the health department and 14 from private agencies. That total of 43 public health nurses left a gap of 19 nurses who were needed for the maintenance of health standards and services in the community. You did not have a great deal of municipally-funded or privately-sponsored health clinics. In fact, in 1927 there were only about 40 or so health clinics in Harlem, nine percent of Manhattan’s total, and they had to accommodate 270,000 residents, or 14 percent of Manhattan’s population. There was a criminalization of magico-religious workers, people who are providing some care, and again I’m not saying that every single one was doing the right thing or really helping, but you had the criminalization of certain people who are providing care, some modicum of care, and then they were not replaced by city-sponsored or state-sponsored health services.



Harlem Hospital is an example of that. Harlem Hospital was a place in the 1930s where people said you went to die rather than to be healed. Harlem had 14 percent of Manhattan’s child and baby clinics, but the proportion was well below the community’s needs, because Harlem’s infant mortality rate was 25 percent of Manhattan’s total. So if we just look at the mortality rates of individuals, the care that people are being provided – or the lack of care – the needs of residents and what was provided didn’t equate.



PA: The community-building process that you describe, and the gap between needs and the actual provision of care, seemed to spur all kinds of political activism. One of the new and important things was the vote. Increasing numbers of Black voters in New York started to leverage their votes, especially around the issue of meaningful health care. Could you talk a little about how that took place?



JAMIE WILSON: Prior to World War I, Blacks had little sway in New York City politics, primarily because there really wasn’t a large concentration of Black voters. Of course, Black people had always been in New York City and many people had voted, even when, in the American South, people could not vote due to disenfranchisement. But after World War I, with the addition of more Blacks to the voting rolls in Harlem, politicians began to listen a bit more attentively to Black voices. You had John Hylan’s election as Mayor in 1917 and 1921, and Black people were organizing, the people who were arriving in the area. In 1917, for example, people like W.E.B. Du Bois were calling on Black people to split their votes between the parties to gain more accountability, and also asking them to consider New York Democrats separately from their Southern white racist counterparts.



This kind of debate has occurred throughout African American history. It is the notion that, in order to make sure politicians listen to you, you can’t put all your eggs in one basket. In the 1917 election, the Republicans received 31.4 percent of Harlem’s vote, the Democrats 20.2 percent, the Fusion Party 20.5 percent, and the Socialists 19.5 percent of Harlem’s total vote. If you look at the particular ways in which people were thinking and advocating, Black people were creating new strategies. And, of course, you also had the United Colored Democracy, which was a Black auxiliary in New York City which also aroused people and got them together.



But as we both know, and I think your listeners know, it is not always the particular forms of voting that called for or caused change in Harlem. If you look at the 1935 race riot, that is what spurred the state to actually do something and the city to actually do something. So when Hylan was reelected in 1921, the NAACP and other community organizations placed issues of health care and hospital discrimination before him as major issues affecting Harlem’s Black population. And in exchange for handling the Harlem Hospital situation and in exchange for handling the poor health care options, they decided to promote the Democratic Party. In 1921, Harlem’s residents voted overwhelmingly for Hylan with 71.4 percent of their votes. So people were now voting for the first time in order to encourage their politicians to look at their particular needs.



PA: That shift in political alignments predates the shift toward backing Roosevelt and the Democrats during the New Deal process. One of the things you discuss in the book about the New Deal is that its policies tended to focus on class-based issues and to sideline or ignore, or mostly ignore, issues that were central to African American communities, and this impacted how New Deal policies affected Harlem. Could you describe that process?



JAMIE WILSON: The New Deal planners looked at what they called the “Negro problem” as a class problem. By improving the economic conditions of workers, their line of argument went, Black problems would be automatically resolved. To a certain extent, I think we can all kind of understand where that was coming from. But because of the condition of Black people in the United States – Harlem itself developed at least partially along racial lines – and because of the racism and discrimination that were prevalent throughout New York City in the 1920s and 30s, one needs to look at the ways in which race and class intersected in that particular geographic and political space.



What I am arguing is that the New Deal responses to Black Harlem residents were at best mixed. Because by not including explicit race-based initiatives and proposals to eliminate segregation and racism, the New Deal policy makers constructed barriers to community development and bolstered structures of inequality. I find it particularly problematic to try to ignore racism in the United States, as if by not explicitly dealing with racism, racism is going to go away, and of course that did not happen in the New Deal.



In some of my research I looked at a particular building in Harlem, at #24 67th Avenue. In the 1930s, as most of us know, the vast majority of Black women were domestic servants, and a large portion of Black men were porters or cooks or waiters – along those lines. The people who lived in this house at 24 67th Avenue in Harlem, over half of them were not even covered by Social Security, because Social Security did not include domestic workers. So we have to look at the particular, racially-based ways that put some Black people into this economic position, and then we need to sit and think about how we can deal with the racist policies that led to it in the first place. This was one way in which the New Deal did not deal with Black working-class issues in Harlem.



Another way it did not really deal explicitly with racial issues was in the discrimination in hiring in the Works Progress Administration and the Public Works Administration. The PWA was created in 1933 as an effort to create employment opportunities for the unemployed, as organized by Roosevelt in his first 100 days. As a result, in New York City in the 1930s, Fiorello LaGuardia created the New York City Housing Authority. The New York City Housing Authority was supposed to create housing for Black people and housing for white people throughout the city. The problem was that even in Harlem, with the creation of the Harlem River Houses, Black people in their community could only receive three percent of the skilled jobs in the construction of the Harlem River Houses. That’s one example of an explicitly racist policy.



I’m not saying that Roosevelt himself was a racist. What I am saying is that the New Deal projects subcontracted to New York City contractors who had traditionally racist views and opposed hiring Blacks. You had the creation of a number of public works throughout New York City and New York State, and Black people could not be hired, and if they were hired, for example for the Triboro Bridge, they were hired in the poor-paying jobs and were restricted to the dirtiest, hardest work.



So, on the one hand, you create these policies absolutely, and they are supposed to bring the unemployed up, but when they employed racist tactics and discrimination and segregation, then Black people did not benefit in Harlem to the extent that they should have. That is part of my argument.



PA: I think one of the most interesting parts of the book is how you show how African Americans in this community saw health as encompassing all kinds of different aspects of social life, from having sanitary housing to safe streets and parks, to access to hospitals and clinics with African American doctors and nurses, and to a good-paying job so you could afford it. What relevance does it have for us today, when we are still debating a lot of these same issues on a national scale?



JAMIE WILSON: Well, I think that world view is the world view of most people. I don’t think that Black people had a particular monopoly on it in Harlem in the 1920s. I think we all understand that health is not just the absence of illness, or the absence of disease, but that it means so much more. I also think that the Black people who were coming to Harlem from these different areas were considering what it means to be healthy and raise healthy children in a new space. I pretty much agree with the World Health Organization definition of health: It is a state of complete physical, mental and social well-being, and not merely the absence of disease. As I note in the book, we can sit and debate all of the varying understandings of health, but if we limit our understanding of health solely to biomedical terms applied in a clinical setting, where good health is often defined by the absence of disease, we miss the point.



In the book I examine different notions of well being and wellness. Throughout the book I use well being and wellness more or less synonymously. By them I mean an intangible, often unquantifiable state of psychological soundness: the absence of dis-ease and the absence of discord. We in many ways know what a state of well being and wellness is by defining what it is not. It is not hunger, it is not anxiety, it is not stress and it is not fear; it is not despair and it is not depression. And Harlem residents in the 1920s and 30s, the working class, the working poor, Black health officials and Black elected officials, were all sitting and thinking about what this meant.



In one chapter, I look at the multiple ways in which they addressed these problems. It was about going into people's homes and helping them, and in some respects cleaning up their houses. It was about going to lobby the mayor and the hospitals in order to get better care. It was about stepping out on your own, which many Black physicians and nurses did, creating their own spaces for people to come and seek care. It was about meeting young women at the bus station and at the train station who were arriving for the first time in Harlem. It was providing lunches and services for people through churches, such as the Abyssinian Baptist Church did. It was about looking at people holistically, about looking at people in their totality, in terms of all the myriad things they come in contact with on a regular basis, and trying to address them. That is what I think is so interesting about the Harlem situation, and that is how I think it is best to understand health and health care in that particular setting.



What comes out for me, as much as history can be didactic and help us learn how to deal with the present, what the Harlem situation tells me, is that one has to have a multifaceted strategy in order to improve health care locally, statewide and nationwide. On the one hand, we need people on the front lines actually providing care. Absolutely these people need to be valued and these people need to be trained. But we also need to have people pressuring the politicians. We elect people to look out for our own well-being, but what I think is absolutely important, in order to create the kind of health care we need – which I think should be a single-payer, state-sponsored health care system – is for us as citizens to fight for what we think we need. Harlem residents improved their community, building a healthy Black Harlem. They improved their community within the constraints of their lives and the political constraints, and we have to do the same thing. We can’t rely on politicians to do it. They are part of the solution but, at the end of the day, we have to create our own vision of what we think health and healthy systems are, and then we have to fight for it.