The USPHS and their partners also moved VD away from earlier stigmas and stereotypes by focusing on the “one-third of a nation ill-housed, ill-clad, ill-nourished.” Syphilis needed to be stamped out not just because it was a threat to industrial efficiency and national recovery but also because it reinforced poverty.
Parran and others often highlighted the ways in which illness, poverty, and ignorance reinforced one another, creating an inescapable cycle for those at the bottom of the socio-economic ladder. Poor living conditions and a lack of education encouraged high rates of disease. This in turn could lead to a loss of a job, continuing this process. As one of the most expensive, serious, and prevalent diseases affecting Americans, syphilis was contributing more than its fair share to this cycle.
Pictorial statistics (infographics) were key to visually representing these more complex ideas about venereal disease, showing the relationship between class and illness in ways accessible to a broad audience. These concerns and beliefs about poverty were tied to the shared experience of the Great Depression. More Americans than ever were struggling or worried about the very real possibility of unemployment and hardship. Framing VD in this way undermined its associations with immorality and sexuality by making it a symptom of an unbalanced economic system and a mutable environment, rather than a result of sin.
POVERTY & HEALTH FOR BLACK AMERICANS
Parran highlighted these ideas in an article for Survey Graphic, “No Defense for Any of Us” (1938) that discussed TB and VD control among Black communities. One of the primary stereotypes about venereal disease was that it was prevalent among all African Americans and this was an indication of their racial difference and inferiority. The Surgeon General and others emphasized that high rates of illness among many African Americans was a class issue. The disproportionate poverty and lack of access to education and health care accounted for higher rates among African Americans. However, rates of VD between whites and blacks of similar socio-economic status were comparable.
While the above infographic from Parran’s book Shadow on the Land (1937) highlights the relationship between class and rates of illness, it only shows syphilis statistics for Black communities. This graphic from "No Defense" a year later (right) does not just juxtapose white and Black rates or show Black rates alone; the image breaks down both white and Black TB mortality rates by class. Though a similar relationship between class and tuberculosis is apparent for both groups, the total numbers of Black TB deaths is about five times as great. While this graphic only shows TB statistics, in the text of the article the Surgeon General made clear that African Americans had disproportionately higher rates of syphilis as well, perhaps six times as great as whites according to national averages.
While Parran obliquely touched on discrimination and segregation as contributing to the status of African Americans in general and specifically in regards to health, Black commentators were much more explicit about this. The major black dailies, the National Medical Association, and others criticized the underfunding of health departments, segregated facilities, the dearth of educational and professional opportunities for black medical professionals, and the irresponsible use of statistics that reinforced the idea that venereal diseases were rampant among all African Americans.
During this time that Parran was publically for greater access to health care for Black communities, he also approved the continuation of the USPHS Syphilis Study at Tuskegee, which lied to and actively withheald treatment from the Black patients with syphilis.
FREE & LOW COST TREATMENT
These ideas about the relationship between poverty and ill health led to support for government subsidized testing and treatment to make care available for all Americans regardless of socio-economic status. Free or low-cost blood tests, exams, and chemotherapeutic treatment were available whether you visited a physician in a public clinic or a private office. The USPHS also developed programs such as a trailer clinic to reach African Americans in rural areas, where rates of VD tended to be highest. The USPHS promoted this mobile clinic in articles and films and the popular press also reported on the program.
This approach to VD control was modeled after other New Deal social welfare programs. The La Follette-Bulwinkle Act, which provided grants to states for VD control based on population and need, followed in the footsteps of the Social Security Act. Title VI of that law had also provided grants to states along similar lines to help develop public health departments and various programs. While this subsidized infrastructure continued to expand during WWII as more money than ever was appropriated for VD control, the rhetoric about poverty and illness became less salient as the nation began to prosper again with war production.