Public Health, Public Art: The Murals of New York City Health and Hospitals at Harlem

The magnificent murals on display in Harlem Hospital’s beautiful Dr. Martin Luther King Jr. Pavilion at 135th St. and Malcolm X Blvd.  provide an inspiration for all of us to contribute as much energy as we can muster to create a healthier society.  I had the honor and privilege to view these magnificent murals recently.

The murals were commissioned in 1936 through the Works Progress Administration (WPA) Federal Art Project, an agency established by President Franklin D. Roosevelt to provide employment to painters, sculptors, and graphic artists during the Great Depression.  In fact, the Harlem Hospital mural project was the first commission for African American artists in the nation.  “The hospital walls provided the canvas for great African American masters such as Charles Ashton, Vertis Hayes, Georgette Seabrooke, Selma Day, Sara Murrell, Elba Lightfoot, and their assistants Jacob Lawrence, Morgan Smith, Louis Vaughn, and Beauford Delaney.” (from exhibit brochure)

The murals were one of the first public works projects in the nation to celebrate African themes and African American beauty and achievement.” ( brochure from the hospital exhibit)

As I viewed the murals, among other things I thought of the pioneering work of Dr. Lester Breslow, one of our nation’s great visionary public health leaders. Dr. Breslow believed that “the root causes of our health problems are broader than our own biology”.   In 1969, as president of the American Public Health Association, he said, “housing may be more important to health than hospitals”.

Viewing the murals provoked deep reflection about the public investment in these murals, placed in a public hospital in the heart of Harlem. The story of these murals is a story that ought to be told broadly.  But more than that, the murals and their location in a public hospital can help deepen understanding of why we must transform health and health care in our nation as part of a broad social movement:

First there is the story of racism .

Even though the Federal government sponsored the project, when it came time for the sketches to be reviewed by the New York City officials in charge of the hospital, the project was rejected!   It took appeals to the President of the United States and New York City Mayor Fiorello LaGuardia by  the Artists Union and community leaders to overturn this decision by City officials who said  at the time that the murals were based on“too much Negro material”. Based on this struggle to have the murals created on the hospital walls, they were completed.

Second, the murals tell important stories with lasting and profound meaning, and the relationship of happiness to health. Two descriptions of the murals provides a sense of their depth and power:

Vertis Hayes created “The Pursuit of Happiness”.  The mural consists of six panels and are 16 feet by 8 feet.  Another two of the panels are 9 feet by 8 feet.  The mural depicts phases of African American life in both Africa and America.  A brochure from the exhibit explains, “these murals serve as tangible monuments to a spiritual people whose difficulties might have been greater without the most human of all elements, their pursuit of happiness.”

Georgette Seabrooke created “Recreation in Harlem”.  This 108 square foot work depicts children singing in a choir, people reading, children playing and wrestling, a couple dancing, a group of women chatting in the park, and other scenes of leisure.  Most of the figures depicted in the mural are women.  From the exhibit brochure: “The artist indicated that she painted what she thought would appeal to people in their off hours”.

Third, the murals symbolize the true meaning of health. All people have a right to  good health, but we know that social determinants are the largest factor in health, not healthcare services alone. The murals make it very clear that people’s health and happiness are interrelated, and that the “pursuit of happiness” should not be only thought of only as a patriotic phrase from our Declaration of Independence, but understood as a matter of struggle.

By seeing health as largely determined by social and environmental causes, we deepen our understanding of what healthcare in our nation must become. The success of medical research and practice over the last 100 years has been remarkable.  So many of the communicable diseases that used to disable and kill people have been eliminated. Today,  many cancers and heart disease can be managed and life can be extended even while living with these serious conditions.

But we have known for a very long time from the studies of Dr. Breslow and many others since, that where people live and the conditions in which they live determine their state of health long before they receive treatment.

The crisis in U.S. healthcare today is the result of many factors.  What is clear is that  we spend more money as a society than any other nation on earth…by far more money, about twice as much as other industrialized  nations, yet our outcomes for our people rank us below all of them.  And our nation’s health and healthcare have disparate outcomes based on race and ethnicity

A few weeks ago, for example,  the New York Times reported on maternal death from childbirth in the United States: Maternal Mortality Rate in U.S. Rises, Defying Global Trend, September 22, 2016.  

Quoting in part from the article:

“The United States has become an outlier among rich nations in maternal deaths, according to data released Wednesday by the Institute of Health Metrics and Evaluation, a research group funded by the Gates Foundation and based at the University of Washington.

There were 28 maternal deaths — defined as deaths due to complications from pregnancy or childbirth — per 100,000 births in the United States in 2013, up from 23 in 2005, the institute found. The rate in 2013, the most recent year for which the institute had detailed data for the United States, was more than triple Canada’s. The institute is projecting that the American rate dipped in the last two years to 25 by 2015.

America’s increase put it above a number of poorer countries whose rates had declined with the global trend, including Iran, Vietnam, Russia and Romania. Medical conditions, like diabetes, which has increased sharply in the population seem to be part of the root cause.  Researchers have theorized that an increase in obesity — particularly acute among poor black women, who have much higher rates of maternal mortality than whites — may be contributing to the problem.”

 The murals at Harlem Hospital should be a focal point of inspiration to accelerate the transformation of the way we think about health and health care in our society.  We can only have good health for all  if the community is healthy, providing meaningful work, affordable and safe housing, the finest education, and access to affordable healthy foods and recreation.

The values associated with equality must be  at the heart of the transformation of healthcare.  We should be very grateful to the artists of the Harlem Hospital mural project and for the public investment in the project.  These are the kinds of public endeavors that actually define  and act on the values of equality.

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