NLM logo

For All the People: A Century of Citizen Action in Health Care ReformFor All the People: A Century of Citizen Action in Health Care Reform

ExhibitionThe Need for Care

Early in the 20th century, rapid industrialization, new waves of immigration, and growing labor unrest made the health of workers and the poor a matter of national concern.

Working people protested dangerous and unhealthy conditions, started worker-owned clinics and hospitals, and advocated for health insurance coverage. African Americans, excluded from mainstream medical care, also created their own health care institutions in the face of segregation.

  • 21 White and African Americans, including children, on steps of a building surrounded by strollers.

    The Urban League, a civil rights organization, co-sponsored this well-baby clinic to combat high infant mortality in African American neighborhoods, Detroit, MI, 1919

    Courtesy University of Michigan-Bentley Historical Library

    African Americans suffered disproportionately high rates of infant and maternal mortality, disease, and malnutrition. Hospitals were segregated by race or absent altogether from black neighborhoods and rural areas. Organizations like the Urban League, founded in 1918, launched campaigns for public health education and medical services in African American communities.

  • 33 African American male and female doctors and nurses gathered for a group photograph

    Interns and nurses at Provident Hospital and Training School, Chicago, 1922

    Courtesy National Library of Medicine

    Most hospitals did not allow African American physicians to practice in them, and many refused to treat black patients. Starting in the late 19th century, African American physicians and community members founded hundreds of black community hospitals across the nation, including Chicago’s Provident Hospital and Training School in 1891.

  • 5 White male miners crouched and standing next to mining equipment underground.

    Miners in Chance Mine, possibly in the Coeur d’Alene region of Idaho, ca. 1909

    Courtesy Library of Congress

    The physical dangers and long-term health hazards of mining made medical care an urgent issue for workers in this industry.

  • Front of a building with 9 White men and women, including nurses standing and seated on porch.

    Park City Miners’ Hospital, Park City, UT, early 20th century

    Used by permission, Utah State Historical Society

    Miners’ unions, whose members had high rates of accidents and disease due to their dangerous jobs, opened more than 20 hospitals in the western United States between 1890 and 1925.

  • Large crowd of White men and women hold banners on a street facing the viewer.

    Demonstration and mourning for the victims of the Triangle Shirtwaist Factory fire, New York, 1911

    Courtesy National Archives and Records Administration

    Following the Triangle Shirtwaist Factory Fire in 1911 that killed 143 workers, mostly young immigrant women, New York City’s garment unions and their supporters rose in protest. Their actions led to new laws regulating health and safety conditions in workplaces.

  • White woman standing behind a crowded desk with arms crossed looks at viewer.

    Pauline Newman, a Lithuanian immigrant, was a garment worker and union organizer before becoming director of the International Ladies’ Garment Workers’ medical clinic in New York City. Photo ca. 1910

    Courtesy Kheel Center, Cornell University

    Health was a major concern of industrial workers who toiled in dangerous and unhealthy conditions. In the absence of universal health protection, some labor unions developed worker-run medical facilities, including hospitals and clinics.

  • White family shelters underneath the umbrella a man holds, as rain clouds hover overhead.

    “Protected,” American Labor Legislation Review, 1919

    Courtesy National Library of Medicine

    This editorial cartoon supports compulsory health insurance to protect workers from losing their livelihoods due to sickness. The campaign for insurance lasted from 1915 until 1920, when it was defeated by opposition from business and the medical profession.