Making Healthcare Accessible to All: The Impact of Nancy Milio on Community Care
Image via the IBX Foundation
Addressing racial disparities in medical care through grassroots work, academia, and policy
This article is part of our “The Power of Nursing” series, celebrating the Year of the Nurse by sharing the stories of influential nurses throughout modern history.
This year has seen greater dialogue about racial disparities in the United States, including within the healthcare industry. There is compelling data to support that such disparities exist. For example, a study conducted by the Center for Disease Control (CDC) in 2019 showed that Black women are two to three times more likely to die from pregnancy-related complications. And for Black women over the age of 30, the increase was four to five times greater.
While awareness of disparities in patient care and health outcomes is a current theme today, these issues are not new. Community-based nurses serving poor neighborhoods in major cities have long-noted the difficulty in getting Black patients to seek care at a hospital or clinic.
Nancy Milio, a visiting nurse in Detroit during the 1960s, asked her patients why they did not seek the further medical care she advised. Their answers were similar: lack of childcare, transportation, or money. Milio was determined to help these communities, and spent her career finding innovative solutions to these obstacles and encouraging the nursing field to do the same.
Milio’s story illustrates how nurses, in providing direct care to patients, had great insight into social issues and the experience to make recommendations that allowed the healthcare system to better serve all patients.
Redefining Community Care
When Nancy Milio was growing up in the Kercheval neighborhood of Detroit, the population was largely Eastern European. By the mid-1960s, when Milio graduated from nursing school, the neighborhood had become lower income and predominantly Black. These were the patients she served when she joined the Detroit Visiting Nurse Association.
When Milio found that her patients were not following her recommendations to get immunizations, prenatal care, or contraception, she wanted to do all she could to eliminate barriers to the care they needed. She founded the Mom and Tots Neighborhood Center in response.
The University of Virginia Nursing School called the center a “community-based institution shaped and directed by the needs and aspirations of the people it was to serve.” The center provided a full-time daycare center, a maternity clinic, and access to birth control and transportation services. The center hired staff from the neighborhood, providing employment in an area without many other opportunities. The Mom and Tots Neighborhood Center became a model for other grassroots community organizations serving at-risk populations.
Addressing Systemic Issues
Nancy Milio recognized there were larger systemic issues that resulted in the Black community being underserved. She also knew that access to healthcare for disadvantaged populations was insufficient to improve their health to the same degree as their white counterparts. She connected the health inequality with growing income disparity, and began academic studies as a means to pursue her passion to impact health care inequality and policy.
In 1965, she graduated with a master’s degree in sociology from Wayne State, where she studied the correlation between socioeconomic status and maternity health standards. In 1969 she left Detroit to gain a PhD in sociology from Yale University.
She served as a professor of nursing and public health at the University of North Carolina at Chapel Hill beginning in 1976, educating countless students and continuing her exceptional contributions to the nursing profession, at the policy level, and to social justice efforts in medicine.
Lasting Legacy
Nancy Milio’s life and career illustrate the influence nurses have in addressing complex social issues and contributing to scholarship that makes healthcare more equitable. Not only did Milio effect change in her own community, she also identified the systemic issues underlying disparate care and took action. Her work and scholarship laid a strong foundation for ongoing efforts to eliminate barriers to healthcare and address racial inequality at large.
The Foundation gratefully acknowledges the consultation provided by Drs. Cynthia Connolly and Patricia D’Antonio of the Barbara Bates Center for the Study of the History of Nursing. This article draws from source material available to the public courtesy of The University of Virginia.