One hundred years later, however, the nursing profession is again called upon to serve during a pandemic. While time has moved forward, the response to control a virus is still encumbered by unequal access to medical care on the basis of race and class. Wealth inequality today echoes the tenements of Wald’s time. Such disparity has real implications for the pandemic response, given that the virus is deadliest for those without the means to seek help. Those who have deferred preventative care in the past later developed underlying medical problems, making them more susceptible to Covid-19.

During the throes of the 1918 pandemic, Wald led the VNSNY to be instrumental in the city’s response to and control of the spread of influenza. While hospitals were “deluged with flu victims,” the VNSNY bravely deployed throughout the tenements of the Lower East Side and across the city. Their physicians attended to hundreds of patients daily. Equally important to their care for the sick, Wald and her nurses provided the City Health Department with vital statistics. These detailed the allocation of resources, claims of profiteering, and the nature of viral transmission.

Wald’s success in combating the 1918 flu was not hers alone, but the result of a tenacious, 25-year campaign that brought together civic and religious leaders as well as underscored the principle that effective public health relies on community engagement. As one biographer points out, “this concept of grassroots connectivity continues to constitute a fundamental construct of visiting nurse services nationally.”

From its inception in 1895, the Henry Street Settlement promoted the idea of public health nursing, a term coined by Wald, expresses the aim to “treat social and economic problems, not simply take care of sick people.” Wald launched a series of advocacy projects in conjunction with community leaders; family planning, personal hygiene, civic education, food safety standards, as well as including nurses and reducing lunch prices in New York’s public schools. They also started arts programs for young people, sought to reform the institutionalization of poverty -- which contributed to child separation -- and the “premature labor” of young people. The doors of the Henry Street Settlement were open to people regardless of religious or racial backgrounds, and, in 1909, the first meetings to establish the National Association for the Advancement of Colored People (NAACP) were held at the Settlement.

While Lillian Wald made it her life’s work to incorporate community empowerment and education into nursing, the healthcare industry has largely turned away from these priorities. As one expert points out, “many factors have combined to largely deemphasize the educational role of visiting nurses and nursing in general—most notably, a public and private payer reimbursement system that has emphasized the technical over the teaching aspects of the nursing role. The result has been the long-standing perpetuation of a volume-based fee-for-service reimbursement system that has, in many ways, fostered client dependency.

Considering her legacy, Wald’s biographer explained that “Lillian D. Wald’s courage, vision, and integrity enabled her to imagine what had not existed before. Her own need \[for and] reliance on community grew out of her realization that no individual acting alone can attain the power of people who are organized and united in a common goal. Always engaged, always a crusader for caring human values, her life was a model of achievement. The creative institutions she built still flourish and continue to grow and adapt in order to meet the challenges of each new generation.”

It is fitting that Wald is on display at the Hall of Fame of Great Americans at the Bronx Community College. The college’s nursing program students have served as nurses and technologists on the front lines of the pandemic at medical centers across the borough. Many of them are from immigrant backgrounds and have also dedicated themselves to the causes of racial and economic justice in public health.