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FACES OF PUBLIC HEALTH |
Correspondence: Requests for reprints should be sent to Joyce Wilcox, Mailman School of Public Health, Columbia University, 722 W 168 St, Room 945, New York, NY 10032 (e-mail: jpswilcox{at}aol.com).
CAROL EASLEY ALLEN, PHD, RN, is a thinker, a doer, and a changer. Allen is a product and a shaper of her times. The immediate past president of the American Public Health Association, She is among the first post– Civil-Rights-era generation of African American women public health leaders and college administrators and is helping to define both of these pivotal roles.
This public health leader' work flows directly from who she is and where she comes from. Allen serves the poor with respect and understanding drawn from her own roots in poverty. Her special relationship with her twin sister, Cheryl Easley, has inspired, molded, and spurred both sisters' careers in public health.
Above all, Allen is a public health nurse with a passion for her profession. She waxes eloquent about carrying the black bag of the public health nurse and passing the public health nursing legacy on to the next generation.
FOUR YEARS IN A SEGREGATED SCHOOL
Carol and Cheryl were born in Huntington, WVa, in 1946. Although neither of Allen' parents finished high school, her whole family loved to read and especially loved literature and poetry. "They were people of high integrity who spoke out about things that weren’t right, giving us a strong sense of social justice," she recalls.
The US Civil Rights Movement changed Allen' life and offered her opportunities denied even her older siblings. "Cheryl and I were among the first to be affected directly by the 1954 Supreme Court decision, Brown v Board of Education, desegregating the schools. I spent the first 4 years of elementary school in a segregated school, then fifth and sixth grades in an integrated school." Allen remembers the lynching of Emmitt Till, a 14-year-old African American murdered in Money, Miss, in 1955 for allegedly whistling at a White woman. "This had a profound effect on me."
Later, Allen participated in the historic Civil Rights Movement, which spanned the 1950s, 1960s, and early 1970s. During summer breaks in college, she prepared food for Black and White activists "sitting in" at segregated restaurants in order to desegregate them. "My grandmother was a professional chef. She cooked in an upscale, segregated restaurant in West Virginia. We could never go there. The Civil Rights Movement liberated that establishment, and for the first time we could go there.
"The strides made during those times were tremendous, but the cost was a lot of suffering and even death. Students today don’t realize that. They take it for granted that they can go to professional schools denied even my older sisters. I don’t want students to lose their history. The Reagan–Bush years set back civil rights. It became acceptable again to voice views that were racist and discriminatory. A social consciousness was lost, and a sensitivity. Under the Bush–Cheney administration, we stand to go back in that direction."
OUTHOUSES IN THE SHADOW OF THE CAPITOL
While in nursing school in the late 1960s, Allen and her sister Cheryl did their public health nursing clinical practices in southwest and northeast Washington, DC. At that time, "Southwest Washington was a slum. There were still outhouses in the shadow of the Capitol.
"Right away I knew that public health nursing was my specialty, and I’ve never looked back. I loved the autonomy we had working with poor families, I loved going to their homes, being able to do our own assessments, and planning our days in terms of what we wanted to accomplish. I loved being outside, getting to know the neighborhood and the community.
"My first job in public health was in Yonkers, NY, working in a practice setting that combined the City of Yonkers Public Health Department with the Visiting Nurse Association. We saw everything that went on in the community regarding health. My district had every cultural group one could imagine—African Americans, varying groups of Hispanic clients, a significant population of Eastern European clients. There were people from Italy, people from the Middle East—from Jordan and Syria. It was wonderful. I learned a lot about how to deal sensitively with people.
"In nursing you learn so much about families and culture. You learn a lot about yourself and how you are able to cope with the disappointments and problems people have in their families. You learn how to negotiate with different members of the family. You learn to manage your time and to make realistic plans for yourself and for the families you are working with. You learn to work with other agencies. You learn a lot about the health delivery system and its problems. We tried to make innovative changes. For example, we tried to make health information available in different languages. This was not always well accepted by the ‘powers that be.’
"I realized that I wanted to go back to school to learn more about what I was doing." So Allen went back to school, eventually earning both her masters and doctorate degrees in nursing from New York University.
Allen' academic career has spanned 8 states and almost 3 decades. She has taught and administered in schools ranging from a New England college specializing in liberal arts to a church-affiliated traditionally Black college in the US South, where she teaches today (sidebar).
CLOSED OUT OF THE "LOCKER ROOM"
Holding a position of leadership in public health as an African American woman has its special rewards and challenges. "Women and Blacks face implicit and explicit issues related to their acceptance, promotion, and advancement. As a woman you are closed out of the locker room, figuratively speaking. As a minority person you are shut out of the country club, figuratively speaking. As a minority woman you are shut out of both and are doubly disadvantaged. You suffer from not being involved in the informal ways that people network and exchange information in order to help and support one another.
"You are expected to be overqualified to perform the same jobs as men and majority people. In the Massachusetts college where I worked, Black and Hispanic faculty were far better qualified educationally than the majority faculty.
"There are some interesting sociological things that are expected of Black women. When I was the vice president for academic affairs in Massachusetts, mothering and nurturing was expected of me from both men and women. A male Hispanic faculty member said explicitly, ‘You are our mother.’ I was expected to do professional work and also to give psychological nurturing in a motherly way."
RESPECTING THE STRENGTHS OF POOR PEOPLE
"In my practice as a public health nurse carrying the black bag, and as a faculty member whose students carry the black bag, we visit people who are extremely wealthy and extremely poor. But the majority of our practice is with the poor.
"I myself know what it' like to be poor, and I know what it' like to practice among people who are poor. You become attuned to the problems people face—their struggles and their courage. Many poor families are extremely strong families or they wouldn’t be able to survive. You become sensitized to the negative ways poor people are characterized in professional journals."
Allen is also interested in the history and social construction of poverty. She has written and spoken on poverty with special emphasis on families living in poverty, and on nursing practices relating to the poor.
LEARNING FROM POVERTY ABROAD
"I got a deeper vision of poverty when my sister Cheryl and I went to Calcutta in 1991 to work briefly with Mother Theresa' Missionaries of Charity. Calcutta is one of the poorest cities in the world. There' noise pollution, air pollution. Your senses are so jarred, it' an assault to the very senses. The things that you take for granted here, like stop lights, were nonexistent when I was in Calcutta, and the roads were bad. When I drive down the roads here, Calcutta comes back to me. I remember that in Calcutta, people are going though trash dumps to find food, and babies are starving. I have the immediate sense that the very poor places I have visited, Calcutta and Uganda, the Philippines, townships in South Africa, are still going on. I am constantly reliving Calcutta. I contrast it all the time to how much we have here and how much we waste."
Allen views public health problems in relation to larger social questions. She encourages others to examine how public health issues fit into a political and social context and, in turn, how political and social considerations influence public health. As president of the American Association of Public Health in 2000, Allen furthered the dialogue on such questions as how society constructs health problems; how the poor, racial/ethic minorities, and women are viewed; how choices are made regarding national priorities such as funding; who is considered "deserving" and who is not; how people' self-view affects their view of others—do people help one another or compete with one another?
REINVIGORATING PUBLIC HEALTH NURSING
Allen seeks to rebuild the base of public health nursing, whose decline she connects to the shift in funding away from public health nursing and toward personal care in health departments. The focus of primary care today is on sickness, she said, rather than on health promotion and prevention, the focus of public health nursing.
"Public health nurses are relatively high cost, and people were looking toward lower-cost workers." While these workers can do discrete tasks, she said, they don’t have the education and broad focus of public health nurses. "The comprehensive role of public health nurses working with families to solve their health problems is being lost."
Today, Allen explained, "research has begun to show that when public health nurses make home visits, there is a difference in public health statistics—declines in infant mortality, for example. Now there is talk across the board about bringing back public health nurses." The traditional and historic public nurse role geared toward health promotion and prevention rather than toward cure and rehabilitation is valued anew. Allen' stated goal is to revive the role of public health nursing in promoting community health.
"Public health nurses are still the largest part of the public health workforce, but our numbers are much reduced. We are about to lose large numbers of public health nurses to retirement. In nursing as a whole, 32 years is the average age of nurses coming into practice, 45 years the average age of nurses in practice, and 54 years the average age of public health nurses with faculty positions. These statistics are also reflected in public health nursing practice and education. We could lose a whole generation of public health nurses who have developed a work culture. Nurses newly coming into public health might not have access to that culture transmitted by nurses in practice. To me, that work culture is part of nursing education. It' important to capitalize now on what we have and revive what is necessary to ensure that future generations of nurses are trained and educated to serve the public, especially the poor."
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