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.The 1920 annual report observed:  teaching health habits tochildren, and [a] determination to make children the most interested per-sons in their own health, is the most important type of work that the com-munity can carry on. The goal was a child  who knows how to keep well.To implement this policy, health instruction increased from ten minutes aweek in 1916 to four hours a week in 1929, and after 1920 school healthweek became a major annual event.49Neighborhood Health CentersHealth education encompassed many different aspects of the lifestyles ofthe families.When visiting and school nurses educated immigrant parentsabout the health of infants and children, they discussed topics such as feed-ing, diet, growth, immunizations, physical defects, mental deficiencies,childhood diseases, and regular checkups.Yet the public and private agen-cies that provided these services were geographically dispersed and ofteninaccessible to immigrant mothers and their children.Each agency alsoHealth Education and Infant Mortality in New York City 137had its own bureaucratic requirements that constituted an additional ob-stacle for the mothers.Consequently, mothers often did nothing until thechild s health problems became severe.If health education was to be aneffective method of improving health, the health department had to orga-nize health services to mesh with the education of parents.The optimumstructure for immigrant families was a conveniently located facility thathoused educational, preventive, and therapeutic health services, expeditedreferrals among them, and minimized paperwork by the family.The health facility used by immigrant families that anticipated thismodel was the milk station.By 1912, according to the annual report, the55 city milk stations provided  places where a mother may obtain puremilk for infant feeding at the lowest market price and in addition mayreceive such instruction as may be necessary from a physician and nurse toteach her how to keep her baby well and the exact method by which itshould be fed. The stations registered all mothers and infants who visitedthem, and 38,000 mothers were registered in 1912.Many mothers visitedthe milk stations only for infant medical care, with 60% of the babies in1912 brought to the stations for the first time being ill.In order to focusthe stations efforts on prevention rather than treatment, the departmentcharged them with all deaths of babies in their districts.The visiting nurseswere assigned to milk stations in the summer of 1912 and given the addedresponsibility of making home visits to mothers who stopped attending.The nurses made 114,000 visits to registered mothers in that summer.50In 1916 the health department acknowledged the expanding func-tions of the milk stations by renaming them  baby health stations. In1917 the annual report explained that the change was designed  to empha-size educational and prophylactic objects of service rather than value ofmilk, as the primary factor in control of infant and child welfare. Fivemajor functions were proposed for the stations in the 1919 annual report:pre-natal care; care and feeding of babies under two years of age; homevisiting during the year and especially the summer; physical examinationsof pre-school children ages 2 to 6 with advice to the family on correctingphysical defects; and provision of space for public and private social serviceagencies.Implementation suffered because of inadequate resources and in-sufficient staffing, which consisted of one nurse and one assistant daily ateach station and one physician for every three stations.51The 1918 annual report observed that the baby health stations  havecome to be recognized as community or neighborhood centers to whichmost inhabitants of the vicinity come for advice and instruction whichrelates to the family. Station physicians made emergency visits to homes138 Health Education for Healthy Lifestylesday and night.The nurses secured the prompt admission of sick infants tohospitals and of women to maternity institutions, and found temporaryshelters for infants and day nurseries for children of working mothers.Theyconducted classes in subjects such as personal hygiene in the home, diseaseprevention, and corrective exercises for those with orthopedic problems.Trained dietitians held cooking classes that emphasized nutrition and cost.Weekly sewing classes and educational programs were held for pregnantwomen.The annual report noted that the  gatherings afforded them a cer-tain amount of social intercourse which relieved the monotony of theirdaily life, and gave them a healthier mental attitude, which is so essentialduring pregnancy. Meetings were also held for high school girls and LittleMothers Leagues (which were now year-round programs that includedcooking classes).The centers furnished desks for private  child-caring, so-cial service, philanthropic, and other agencies, as well as maternity cen-tres. Health education was provided at the centers to nurses, physicians,midwives, social workers, and public health students.52One of the most successful devices for attracting residents to the cen-ters continued to be the sale of milk, which the department characterizedas  the poor man s food. The milk was originally intended for infants, butwas later consumed by nursing mothers, pregnant women, older childrensuffering from malnutrition and other disorders, adults suffering or conva-lescing from tuberculosis and other diseases, and others in need and unableto pay regular prices.Approximately 5.8 million quarts were sold annuallyfrom 1917 to 1920 at a price per quart varying from eight cents in 1916 toeighteen cents in 1920 (after a period of war-time inflation), a savings ofthree-to five cents compared to the market price.53A basic deficiency of the stations was their failure to serve certaingroups of children, including many of the sickest and neediest infants.In1919, 43% of all deaths during the first year of life occurred in the firstmonth of life, yet from 1915 to 1920 only 11% to 14% of the approxi-mately 40,000 infants under one year of age who attended the stationsannually were brought there in their first month.The infants brought tothe stations were increasingly in good health and the mothers regular inattendance and receptive to the advice of the nurses.This suggested thatthe poorest and least educated mothers were not using the centers.To reachthese women, the 1920 annual report stated that the stations lengthenedthe intervals between visits for healthy infants and sent visiting nurses tothe homes of infants who were  weak, delicate, sick, or suffering from mal-nutrition [ Pobierz całość w formacie PDF ]