Sin or folly: Child and community health in Philadelphia, 1900-1930

The child welfare movement in the first third of the twentieth century marks a turning point in the history of American child health. In this period most European nations created government-based programs to safeguard the health of mothers and young children in order to ensure a vigorous and numerous population. The United States did not, in part because recent immigrants seemed to provide a sufficient number of able bodies for a growing industrial nation. In the absence of federal or state legislation, American reformers launched a variety of voluntary and municipal programs to improve the health of children. They focused on working class and indigent families because it seemed obvious that the behavior and living conditions of the poor led to disease, an association reinforced by statistics such as the infant mortality rate. Child health was transformed from an issue of national concern for all children to a local problem of poverty, where it faced America\u27s long history of ambivalence towards welfare. Although eager to help the innocent poor, especially children, reformers also believed that most poverty was self-inflicted. Public medical care, for example, was sharply limited by fears of encouraging dependence, while strategies relying on education and self-help proved overwhelmingly popular. Despite these limitations, in the 1910s children\u27s health clinics expanded their formerly narrow medical role to offer extensive social services. As social work became institutionalized in separate departments, however, child health issues became even more rigidly defined as either medical or social, with each category seeming to require different expertise. This case study focuses on one city because efforts to improve child health were usually organized at the municipal level, but conclusions drawn from the example of Philadelphia apply to all of America. Indeed, recent child health policy continues to reflect the seemingly rigid divisions that arose in the first third of the twentieth century: child health as a problem of the poor, not of the nation; poverty and environment as problems for the social worker, not the physician