Strategies of neighborhood health-care among New Orleans blacks: from voluntary association to public policy
Description
Various aspects of the culture of North American blacks have been overlooked by anthropologists. Health as it relates to culture is an example of one topic that has been ignored. Yet, an analysis of the health status of blacks and their health- care behavior can provide significant information for the social scientist and can assist those who are involved in making improvements in systems of health-care delivery From the earliest records of colonial Louisiana, high rates of morbidity and mortality have plagued the black population in the area. As a result of these factors, as well as certain attitudes and behaviors of the local white population, blacks in New Orleans since the Emancipation have skillfully devised neighborhood level strategies within the Western medical tradition to attend to their own health needs. The changes that have occurred in these health-care strategies have paralleled changes in the social structure of New Orleans as it shifted from a Reconstruction social structure to the social structure of the New South and have been associated with changes that occurred in the area's pattern of black mortality The health-care strategy which best characterizes the Reconstruction social structure is that of voluntary associations, the benevolent societies. These organizations provided their members with physicians' services, medicines, pensions during illness, burial assistance, and death benefits. In addition to performing these functions, they provided their members with skills in organization, promoted a religious sentiment, perpetuated elements of Creole culture, encouraged thrift and saving, provided an ideology which helped to strengthen and unify the black community, and added to the social life of New Orleans The health-care strategy which best characterizes the social structure of the New South is one in which blacks utilized new power options to take advantage of national social policy of the late 1960's and early 1970's to form neighborhood health clinics. In addition to providing health-care, in a fashion not unlike the benevolent societies, these clinics have provided blacks with new skills of organization, sponsored training in the health professions, served as one of the symbols of the black cultural revolution of the 1960's, allowed expression of black religious values, and strengthened the local black community While a new form of health-care delivery has emerged, the pattern of health-care behavior among blacks appears to be linked to the prior experiences of this population. A long history of limited access to the city's larger health-care facilities combined with antagonism from local whites has resulted in high levels of anxiety with respect to health among blacks and poor patterns of follow-up in the present clinics. This is demonstrated through examining medical records, responses to the Cornell Medical Index, and answers elicited through use of health related sentence frames. Therefore, the major challenge of the new form of neighborhood health-care delivery in the city appears to be related to changing the value orientation of blacks from one that considers health as an instrumental value to one than considers health as an intrinsic value An annotated list of black benevolent societies from the late eighteenth century to the present is included, as well as financial information of several associations. Rates of black mortality and statistics on morbidity from 1880 to the present are provided