AJPH HISTORY

Cleveland Versus the Clinic: The 1960s Riots and Community Health Reform

Merlin Chowkwanyun, PhD, MPH

During the 1960s, cities across the United States erupted with rioting. Subsequent inquiries into of operating with little regard its sources revealed long-simmering discontent with systemic deprivation and exploitation in the for those who lived in the sur- country’s most racially segregated and resource-scarce neighborhoods. Urban medical centers were rounding environs. The depth not exempt from this anger. They were standing symbols of maldistribution, cordoned off to those of their responses ranged widely, without sufficient economic means of access. In this article, I examine the travails of the world- from rhetorical genufl ection to famous and prestigious Cleveland Clinic after the 1966 riot in the Hough neighborhood on the East serious infrastructural invest- ments. The Cleveland Clinic’s Side of Cleveland, Ohio. After years of unbridled expansion, fueled by federal urban renewal efforts, response ultimately fell some- the riots caught the Clinic’s leadership off guard, forcing it to rethink the long-standing insularity where in between. And what between itself and its neighbors. The riots were central to the Clinic’s programmatic reorientation, transpired in the years imme- but the concessions only went so far, especially as the political foment from the riots dissipated diately following the events in in the years afterward. The Cleveland experience is part of a larger—and still ongoing—debate on Hough played a critical role in social obligations of medical centers, “town–gown” relations between research institutions and that change. their neighbors, and the role of protest in catalyzing community health reform. (Am J Public Health. 2018;108:1494–1502. doi: 10.2105/AJPH.2018.304654) THE RECKONING Right after Hough, Cleveland n July 1966, the Hough story of a gulf, one between a authorities took their cue from Ineighborhood on the East gilded medical institution and a counterparts in other riot- Side of Cleveland, Ohio, ex- racially segregated neighborhood stricken cities: they convened ploded and saw nearly a week right next to it: the Cleveland a commission. The fi rst offi cial of rioting. It followed a 1964 Clinic on one hand, the Hough analysis came from a Grand Jury riot in Harlem, New York—the neighborhood on the other. In assembled by Cuyahoga County, largest up to that point in the the decade preceding the riot, where the city was located. It post–World War II period—and the Clinic had expanded rapidly, listed grievances that included other unrest throughout the de- displacing, alienating, and anger- “inadequate and sub-standard cade in Philadelphia, Pennsylva- ing its neighbors as it made way housing,” “charging of exorbi- nia; Chicago, Illinois; and, most for an ever-growing medical tant rents by absentee landlords,” famously, Los Angeles, Califor- complex. It was a prime player “sub-standard educational nia, among others.1 Whether in “urban renewal,” the mid- facilities,” “excessive food prices,” labeled “rebellions,” “uprisings,” century phenomenon whereby and “denial of equal opportuni- “civil disorders,” or “riots,” this scores of neighborhoods were ties,” all of which were becom- tumult was a national wake-up condemned by public authori- ing a standard list in similar riot call, particularly for powerful ties, frequently razed, and then commissions elsewhere.4 Mayor institutions that had insulated replaced with everything from Ralph Locher convened an themselves from the rage stew- parks and new housing units “emergency committee” that ing around them.2 to retail outlets, hospitals, and identifi ed similar themes, point- Urban medical centers were universities, often for the more ing to chronic unemployment among such institutions. Flush affl uent.3 and irregular trash pickup. One with resources from midcentury The 1966 Hough riot halted passage on run-down housing in medical expansion, they were the Clinic’s expansion plans Hough declared that these “must standing symbols of maldistribu- and, in turn, changed how it have been a contributing, if not tion, closed off to those without dealt with its neighbors go- a causative, factor in the riots.”5 suffi cient economic means of ac- ing forward. For similar urban The most charged of the cessing them. Cleveland was no institutions across the country, Hough analyses, however, came exception. This article tells the this moment followed decades from activist circles outside of

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formal governmental channels.6 An ad hoc Cleveland Citizens Committee on Hough Distur- bances held its own hearings featuring long-time activists and everyday residents. The bulk of its report was devoted to chroni- cling Hough’s resource depriva- tion and argued that

to many, it seemed almost inevitable that such neglect and disregard would lead to frustration and desperation that would finally burst forth in a destructive way.7

Unlike the other reports, though, the Citizens Committee specifi cally spotlighted urban re- newal, pointing to its disruptive eff ects and powerful institutions in or near Hough that were part of it. One passage came from Daisy Craggett, a columnist for Cleveland’s Black newspaper, the Call and Post, and a long-time Hough resident. Craggett argued Note. In this Cleveland map, I georeferenced Cuyahoga County “social planning areas” with 1970 US Census tracts and achieved a 100% match of boundaries.55 that

Racial Segregation in East Cleveland and Locations of Cleveland Clinic and Western Reserve in University Circle/Hough Area (1970) there was no real commitment to the people in Hough nor a medical constellation next to an affl uent clientele, and, by the Negro community. . . . the Hough neighborhood. Of its own estimates, about two We have seen Urban Renewal actually come in and destroy the two biggest institutions in thirds of its patients came from what was once a good com- the area, University Hospitals outside not just Cleveland but munity.8 was the least insulated from greater Cuyahoga County.12 its neighbors. It was affi liated One advocacy group would Tonal diff erences notwith- with Western Reserve Uni- later describe it as rising from standing, these three bodies versity and admitted a large “hospital-based slum clearance” declared that rioting was not percentage of indigent and that had just a random occurrence. It was low-income patients as part catalyzed, rather, by simmering of medical school training.10 reached city-wide proportions, frustration: over deprivation, over Its direct foil was the Cleve- with a number of east side insti- exploitation. For at least some land Clinic. Founded in the tutions participating in a coor- dinated effort to create a “white of their participants, then, riots 1920s, the Clinic, in less than corridor” of renewed areas amounted to an expression of a half century, had expanded through the east side ghettos.13 discontent, even protest, or what from modest roots in a four- Martin Luther King Jr. called story building to a citadel that Whatever one thought of “the language of the unheard.”9 spanned from East 90th Street such rhetoric, the underlying When it came to medical to East 93rd Street. It was no factual claims were basically resources, the problem on the ordinary medical complex but true. One of the country’s most East Side of Cleveland was not the elite of the elite, famous prestigious medical centers a lack of institutions. Rather, it for pioneering technology stood within walking distance was lack of access to existing used in heart surgery.11 The from one of its most racially ones, for the area was home to Clinic primarily catered to segregated and low-income

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neighborhoods. Hough was the blight”—via large-scale physical Hough’s momentary contain- byproduct of multiple trends removal of perceived health ment.22 But the end of the riot in the 1950s: an exodus of threats and the construction of a few days later hardly quelled White residents from the city, new medical facilities in their the fears of administrators, an infl ux of Black residents, and place.18 In a 1965 speech, given who debated the future of the entrenched housing discrimina- about a year and a half before institution’s relationship with tion that “trapped” most Black the Hough riots, Thomas Hatch, the East Side of Cleveland. They Clevelanders in just “several the Clinic’s urban renewal coor- worried that the Clinic might square miles of the East Side.” dinator, stated—without irony— be a target sometime in the It all occurred within larger that the Clinic hoped to future. The tone of many meet- economic turbulence. Many ings was a fusion of sentiments, cities with once-robust industrial clear a blighted and deteriorat- as administrators expressed cores saw them (and their jobs) ing neighborhood, and to pro- frustration over stalled plans, dissipate in the 1950s, as major vide an improved environment befuddlement over what had where health care, health edu- fi rms shifted operations to tax- cation, and health and scientific happened, and occasional obliv- 14 friendlier areas elsewhere. research can be conducted ef- iousness about residents’ views But the Clinic stayed. And fectively for the benefit of the toward the Clinic and expan- it became a major entity in the people whom we serve.19 sion, all mixed in with resigned area’s landscape, having actively admission about the need to lobbied and planned a second However well-intentioned, change direction. At the end of phase of the “University–Euclid” such a statement also refl ected 1966, Urban Renewal Director urban renewal project, named a parochial insularity from the Hatch captured Clinic offi cials’ after one of the city’s main thor- sentiments of everyday people collective mood, writing of a oughfares. Approved in 1961, the surrounding the institution. federally funded project would Few city offi cials publicly crisis situation in Hough—can- enable the Clinic to spearhead, challenged the urban renewal not overemphasize its gravity. with the aid of federal urban eff ort. One exception was Leo Poor commentary on Cleve- renewal dollars, a “Health Sci- Jackson, a Black Cleveland City land community, which was ences Center” stretching as far Council member. In one meet- once noted for good racial re- as East 75th Street westward and ing with Clinic offi cials, Jackson lations. . . . Ferment is seething. East 109th Street eastward.15 An stated that his constituents sim- earlier and smaller phase of the ply wanted “decency and pro- Hatch added that the “fuse is project had displaced 1456 fami- tection of present property,” not set—small incident, as in Watts, lies, 70% of them “non-White” urban renewal.20 As chairman could set it off ,” a reference to (and almost all Black). If com- of the city council, Jackson the 1965 riots in Los Angeles’s pleted, this expanded phase had used his control of parliamentary largest African American neigh- the potential to displace many procedure to stall approval for borhood.23 Moving forward, he times more, “1,600 structures the project components. The declared that “massive eff orts are containing 5,200 dwelling units” standoff continued into May needed” and that “timidity and and “21 000 people” by one esti- of 1965, angering the Clinic’s half measures” toward alleviating mate conducted at the time.16 administrators, who groused the suff ering of the most mar- When proposing plans to privately over council members ginalized “have not paid off .” 24 It government offi cials, Clinic who were “part of [Jackson’s] was both a self-indictment of the administrators drew on familiar Negro bloc.”21 Clinic and a critique of broader (and implicitly racial) imagery American society. to accentuate the problem of so- Fear pervaded among Clinic called “blight” and then propose THE CLINIC ON THE executives. Into 1967, they mon- an expanded Clinic as a solu- DEFENSIVE itored rumors of future riots, tion.17 These invocations revived The 1966 Hough riots speculating that “agents of un- a powerful trope in 20th-century abruptly halted the Cleveland known and subterranean leaders public health planning whereby Clinic’s expansion, and they put are at work.” They pondered the demolition and urban renewal the institution on the immedi- reliability of information gath- were promoted as health ate defensive. Two days after ered from “responsible Negro remedies—what Samuel Roberts they started, a Cleveland Clinic leaders,” whom they suspected has called the “medicalization of offi cial expressed relief over were poorly connected with

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Note. The numbers 1 and 2 mark the same geographic location in each respective photograph.

Cleveland Clinic ca. (a) 1930s to (b) Late 1950s to Early 1960s actual “militants.” The Clinic these people would harm pa- which they feel holds them in even began crafting emergency tients or unresisting personnel. bondage.”26 They would only hurt their plans in the event of another own cause—and bring total, uprising, which would include lasting retribution on their the hiring of its own private own [heads].25 CONCESSION: THE EAST “guard force” and an additional SIDE HEALTH CENTER layer of “squad leaders” com- Much of the Clinic’s think- Two years after the 1966 posed of “men with previous ing was rooted in racially riots, the Clinic was still debat- military service, especially com- charged paranoia that exhibited ing a number of paths, including bat experience.” Clinic offi cials considerable ignorance, espe- everything from relocating en- also discussed strategic “with- cially comments that depicted tirely to improving community drawal points” in the event the rioters as a largely irrational and outreach.27 But the Clinic’s own facility became besieged, along violent “mob,” not people with internal deliberations on these with the use of nonlethal weap- grievances that required a seri- matters were not the only ones onry that included “fi re hoses ous reckoning. Some within the of consequence. Rapid devel- with 2.5 inch streams” to thwart Clinic, however, characterized opments in Cleveland politics “the mob and drive it back,” rioters as people with a “cause.” played a role in the Clinic’s tear gas, and “riot guns, which This faction of the Clinic’s lead- future, too. The Hough riots are more likely to injure than to ership ultimately accepted what had killed support for Mayor kill.” An extreme scenario called the other analyses of the Hough Locher, a White politico and for “ultimate weapons,” includ- riot had revealed as well, that mainstay in the local Democratic ing “fi re-arms, pistols, and rifl es” “dissatisfaction is rife, and grow- Party machine. And a year later, reserved for anyone who man- ing, with housing conditions, Carl Stokes, a Democratic state aged to enter a Clinic building. employment ‘opportunities,’ representative, became the fi rst One offi cial pondered the worst city services, police treatment, Black mayor of a major Ameri- potential case: and other unsolved problems.” can city.28 Behind the language of mobs For the Clinic, Stokes’s Suppose a mob stormed the and militants was an acknowl- victory was actually welcome. place—what would it be likely edgment, in other words, that During his campaign, Stokes to do once it got in? Prob- rioters’ “attitude . . . is that had deftly positioned himself as ably try to find narcotics and food—but, it is hard for me conditions are intolerable, and an alternative to two political to believe that even under the they are anxious to precipitate poles. He was neither a member most imaginable circumstances, changes in the social system of the White ethnic machine

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for them, in addition to sharing tion. Although the events of existing Clinic personnel.31 1966 occurred in Hough, on By cooperating with Stokes, whose southern boundary the Clinic benefi tted from the the Clinic was located, facility political symbolism that came planners proposed instead to with supporting a Black politi- build in Fairfax, a neighborhood cian, even as it never tethered immediately to the south of itself to a policy program that Hough. Overall, Fairfax’s racial fundamentally challenged the composition was not a huge status quo. It could also shed its contrast from Hough’s. But the reputation as an isolated medical Clinic had identifi ed diff erences fortress unconcerned with its between the two adjacent neigh- neighbors. Stokes could respond borhoods, particularly when powerfully to public clamor for it came to class. The Clinic’s proactive political response to internal assessment of Fairfax the conditions that had precipi- characterized it as a “stable com- tated the 1966 events. And he munity” with a high percentage of could also draw on the Clinic to Black middle-class homeowners. advance a reworked vision of Moreover, the report continued, Note. The darkened streets are out- nor a fi rebrand in the mold urban renewal. Urban renewal 2.0, Fairfax had largely avoided a lines of boundaries—extending 30 of Leo Jackson, the Clinic’s it might be called, maintained higher infl ux of midcentury blocks—for the proposed pre-riot Black primary opponent on the midcentury’s fundamental Black migration because it “was University–Euclid Urban Renewal the City Council. At heart, urban growth imperatives but already fi lled with a ‘higher class’ Project. as the political scientist Todd softened its edges—no more of resident,” and, in the Clinic’s Swanstrom later put it, Stokes razing, no more overt displace- view, was a bright spot that pos- University–Euclid Urban Renewal Project (Phase II) was “somebody [that] busi- ment—and tacked on some sessed many “values” amid the ness”—and other establishment ameliorative alterations, namely otherwise “deteriorated appear- institutions—“knew they could local programs for job creation ance of the east-west through work with.” (Another indicator and youth development. Stokes’s streets.”34 In choosing Fairfax, of Stokes’s politics came in his program, dubbed “Cleveland the Clinic could no longer wall 1973 memoirs, which included Now!,” garnered Clinic sup- itself entirely from the city, but a chapter memorably titled port.32 All throughout, Clinic it could still fi lter who came “How to Get Elected by White offi cials exhibited keen aware- through the doors of its new People.”29) ness of public image, with one extension via subtle relocation. Even with Stokes, the city’s commenting that A site slightly outside the racial climate remained charged, immediate boundaries of Hough especially after a shootout in July would also allow the Clinic to the public relations aspects of 1968 in Glenville, a neigh- could conceivably even take on establish a beachhead for future borhood on the East Side of national dimensions due to the westward expansion, which it Cleveland, about a mile north Mayor’s prominence and popu- had never put completely to bed. of Hough.30 Earlier that year, larity on the national political The Clinic’s report on Fairfax 33 Stokes summoned representa- scene. speculated that the city could tives of Cleveland medical facili- become “a center for education, ties and pressed them to share medicine, culture and the several more of their resources with the POSTǕRIOT: THE LIMITS arts.” The economic growth of city. The Clinic responded to OF CONCESSION Cleveland along such lines, in Stokes’s request without hesita- The new East Side health turn, would be bound up with tion and soon hatched a plan center was certainly a con- institutions like the Clinic. Host- for a brand new East Side health cession. Yet, throughout its ing its satellite center was one center providing outpatient care. development, the Cleveland of many ways for the Fairfax The city would fi nance building Clinic persistently searched for neighborhood—and the nearby and land costs, but the Clinic ways to align the project with its Clinic—to remain part of the would handle staffi ng by recruit- own self-interest. One example process.35 And, in the big picture, ing physicians in the area and was the Clinic’s deliberation it would fulfi ll, in the words of providing Clinic employee status over the facility’s precise loca- one Clinic offi cial, “a feeling of

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moral obligation” while aiding Overall, though, the Cleve- brought signifi cant medical the “preservation of our interests land Clinic was moving from resources and job opportuni- in the local community.”36 a central role in the East Side ties, including the hiring of Despite such lengthy delib- health center plans to a more up to 500 local residents.43 At erations about the new health complementary one. Besides the same time, the headline of center, the city of Cleveland it- Cuyahoga County, another another story in the same issue self failed to move forward with new player in supporting the asked and answered a pointed a critical end of the bargain: East Side center’s development question: “Who pays for care of allocating the land and con- was the Fairfax Foundation, poor? Not the Clinic.”44 It cap- structing the facility’s physical composed of Cleveland civic tured the prevailing perception plant. Part of this was attribut- boosters. The Fairfax Founda- of some segments of the city able to Mayor Stokes’s travails. tion’s participation meant that toward the Clinic: that it had Although reelected in 1969, the charged symbolism around done some, but not enough. But he became politically besieged the original project—a rever- now, the political agitation that by an antagonistic city council, sal of the Clinic’s neglect and might pressure it to do more was and his problems culminated in exploitation of those around absent. a decision not to seek a third it—instead became draped in The Clinic continued sup- term.37 the more politically palatable porting the Clement Center, The Clinic, however, never language of metropolitan eco- though it saw it as part of dropped the East Side health nomic growth.40 nascent urban growth and com- center entirely. It might have Refl ecting the times, by munity development trends of done so were it not for a the late 1970s, the Clinic was the time.45 By the early 1980s, coincidental development in rebooting expansion. It did so, the Clinic revived many of its 1971, when Cuyahoga County however, on its far eastward side plans for westward expansion, offi cials pushed for a major on East 105th Street. There, one often in concert with booster overhaul of the county health found a minor-league empire groups. That same year, the system. One component of the of eateries, stores, bars, and adult Greater Cleveland Growth As- overhaul called for the construc- businesses owned by Winston sociation, Cleveland’s version tion of “primary care health Willis, a Black entrepreneur who of the Chamber of Commerce, centers” to relieve severe out- regularly antagonized the Clinic proposed expansion in Uni- patient pressure on the public with obscene billboards and versity Circle, a neighborhood facilities.38 Clinic offi cials saw fl yers that derided it as a racist directly adjoining the Clinic and that they could take the long- institution.41 But the Clinic University Hospitals.46 The in- delayed East Side center project seemed less concerned with Wil- stitutional behavior that angered and latch it onto the new lis’s attacks—and the collective so many in the 1960s was now county goals, all while shrink- political reaction that they might once again proceeding apace in ing the Clinic’s own role. Now, generate—than would have been the 1980s. That same year, newly Cuyahoga County would over- the case just a decade before. The elected Mayor George Voinovich see the East Side health center’s fury around land use in the area proposed that the Clinic play formal development, and it had long since died down. an integral part in a city-backed would open as a county facility. In 1976, after numerous false development eff ort on the East The Cleveland Clinic would starts, the county’s Kenneth Side of Cleveland. He called the lend its imprimatur, contribute Clement Center fi nally opened, Clinic “the single most important $100 000 annually for the fi rst bearing the name of a promi- institution within this economic two years, and assume 50% of nent Cleveland Black physician. revitalization target area.”47 annual defi cits (but with a cap A story about it in the liberal The Clinic proceeded as it of the obligation at $200 000), Cleveland Press granted that the once had but with well-chosen a relatively modest fi nancial Clinic had made strides in ac- deviations from what it had obligation. (At one point, cruing a “record of community done in the midcentury. In ad- county offi cials admonished the service.” It cited the Clinic’s dition to the Clement Center, it Clinic for what they saw as a role in developing the Clement pushed for Clinic employment half-hearted fi nancial commit- Center, followed by laudatory of “targeted populations” and ment.39) The Clinic’s most sub- quotations from Cleveland civic “planning an on-going strategy stantial contribution remained fi gures that praised the shift in to inform and involve” what it loaning Clinic personnel. orientation.42 The Center indeed called “the Minority Business

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Community.”48 These gestures revitalization and private institu- from the incorporation of pro- were a testament to the Hough tional expansion as inseparable. testors into formal government riots and their residual impact. The question to be asked about to militant repression of activism In the 1980s, the Clinic and such eff orts, of course, was and by law enforcement.53 Today, other Cleveland institutions is: “For whom?” broader questions about societal were never able to expand as About 15 years after the obligations linger for elite urban widely—and without checks— Hough riots, Henry Manning, medical centers, which still as the original 1960s urban President of the Cuyahoga blend uneasily with neighbor- renewal program would have County Hospital system, ap- hoods surrounding them. Yet allowed. And when they did peared before a 1980 federal there are now signs of renewed expand, they could no longer Congressional committee on attention to racial and economic do so without inclusion of those “fi nancially distressed hospi- inequality.54 One hopes our col- who would have been ignored tals,” which hosted medical care lective response will be enough before 1966. Whether that inclu- administrators from around the to not once again be caught by sion amounted to tokenism is an country. Early in his exchange surprise. open question. with Manning, Senator Howard Metzenbaum, a liberal Ohio ABOUT THE AUTHOR Merlin Chowkwanyun is with the Depart- Democrat, characterized the ment of Sociomedical Sciences, Mailman THE RIOT LEGACY Clinic bluntly: “They stand out School of Public Health, Columbia University, The Clement Center itself like a sore thumb in Cleve- New York, NY. Correspondence should be sent to Merlin successfully helped ease medi- land for not accepting a share Chowkwanyun, 722 W 168th St R931, cal maldistribution on the East of responsibility.” After Man- Mailman School of Public Health, Columbia Side of Cleveland. In 1984, ning mentioned the Clement University, New York, NY 10032 (e-mail: [email protected]). Reprints can be 54% of new patients were Center, Metzenbaum continued ordered at http://www.ajph.org by clicking the medically indigent.49 And in its to chastise the Clinic for not “Reprints” link. actual programming, the Center making more eff orts to serve This article was accepted July 4, 2018. doi: 10.2105/AJPH.2018.304654 implemented several innovative medically indigent patients, practices, many of them similar arguing that there had not been ACKNOWLEDGMENTS to other neighborhood-level enough “peer pressure” by other I would like to thank the Cleveland 51 Clinic Archives, Monica Gisolfi , Abbey medical care experiments else- medical providers in the area. Sussell, Yoka Tomita, David Kindig, where in the city and country. As the journalist Dan Diamond Brent Cebul, Connie Nathanson, Kavita These included the use of health has chronicled, this remains the Sivaramakrishnan, David Johns, David Rosner, and Ronald Bayer for discussions, teams, focus on long-term reputation of the Clinic for comments on a draft of this article, and health maintenance of patients many everyday Clevelanders queries answered. before and after they used the today.52 facility, and training of staff to Senator Metzenbaum’s ENDNOTES 1. Thomas Sugrue, Sweet Land of consider patients’ day-to-day observation about the Clinic Liberty: The Forgotten Struggle for Civil surroundings and their impacts resembled the observations Rights in the North (New York, NY: on health.50 Clinic offi cials had privately Random House, 2008), 325–326; Re- port of the National Advisory Commission But in the grander scheme, made among themselves im- on Civil Disorders (Washington, DC: US the Cleveland Clinic’s eff orts mediately after Hough, when Government Printing Office, 1968). were a minor remedy for a city they acknowledged that they 2. Imperfect as the term is, I will use and neighborhood riven with could no longer remain a glitzy “riot” for the remainder of this article. On connotations attached to riots, see entrenched inequality. Cuyahoga medical island amid rampant Jonathan Metzl, The Protest Psychosis: How County offi cials had performed poverty and racial exclusion. Schizophrenia Became a Black Disease (Bos- most of the actual politick- The Clement Center and other ton, MA: Beacon Press, 2010). ing and planning to bring the outreach eff orts were certainly 3. On urban renewal, see Herbert J. Gans, The Urban Villagers: Group and Clement Center to fruition. As bridges connecting it to some of Class in the Life of Italian-Americans fear of attacks against the Clinic the broader neighborhood. But, (New York, NY: Free Press, 1962), es- declined, so did the urgency for ultimately, was an island still an pecially chapters 13 and 14; Jane Jacobs, The Life and Death of Great American the Clinic to take on wider- island? Cities (New York, NY: Random House, scale and monetarily deeper Throughout the country, 1961); Martin Anderson, The Federal commitments. Meanwhile, a political foment rapidly declined Bulldozer: A Critical Analysis of Urban Renewal, 1942–1962 (New York, NY: new municipal policy environ- in the decade after Hough. That McGraw-Hill, 1967); and, more re- ment emerged, one that saw city was attributable to everything cently, Arnold Hirsch, The Making of

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the Second Ghetto: Race and Housing in January 5, 1966, in Box 1, Office Files, different waves of urban renewal Papers; Moore, 73–76; Swanstrom, 105. Chicago, 1940–1960 (New York, NY: Clipping Files 1965–1966. efforts, see Roberts, Infectious Fear, The program fizzled after one of its Cambridge University Press, 1983); 201–221; Russ Lopez, “Public Health, grants was linked to weapons purchases 13. Terry Demchak, Barbara Ehren- Samuel Zipp, Manhattan Projects: The the APHA, and Urban Renewal,” by a Black nationalist named Ahmed reich, and the Cleveland Women’s Rise and Fall of Urban Renewal in Cold American Journal of Public Health 99, Evans that were later used in the Glen- Liberation, Health Task Force, “People’s War New York (New York, NY: Oxford no. 9 (2009): 1603–1611. ville incident. Guide to Health Care: The Politics University Press, 2010); Andrew High- of Health Care,” January 1972, in Ms 19. Thomas Hatch, “University-Euclid 33. Richard Gottron, “Plan for a Com- smith, Demolition Means Progress: Flint, Coll. 641, Folder 522, Medical Com- Urban Renewal Program Phase II,” munity Health Facility”; LeFevre to Michigan, and the Fate of the American mittee for Human Rights Papers, February 3, 1965, in Box 23, Folder 3, Wilson. Metropolis (Chicago, IL: University of Kislak Center for Special Collections, Gottron Papers. Chicago Press, 2015); and Francesca 34. Thomas Hatch, “The Fairfax Rare Books, and Manuscripts, Univer- Ammon, Bulldozer: Demolition and 20. Cleveland Clinic meeting with Community,” June 5, 1969, in Folder sity of Pennsylvania, Philadelphia, PA. Clearance of the Postwar Landscape Ralph Locher and Cleveland City “Mayor Stokes’ Plan” (semi-processed), (New Haven, CT: Yale University Press, 14. For background on Hough, see J. Mark Council; Thomas Hatch, daily journal Cleveland Clinic Archives. This intra- 2016). Souther, Believing in Cleveland: Managing entries, May 19, 1965, and May 26, racial distinction made by planners at 1965, in Box 23, Folder 4, Gottron a predominantly White and elite in- 4. “Special Grand Jury Report Relat- Decline in “The Best Location in the Na- Papers. stitution calls to mind Arnold Hirsch’s ing to Hough Riots,” 3–9, 11, August tion” (Philadelphia, PA: Temple Univer- account of University of Chicago and 9, 1966, in Box 23 Folder 6, Papers sity Press, 2017), 45–70; David Stradling 21. Thomas Hatch, daily journal en- its administrators’ resigned acceptance of Richard Grotton (semi-processed), and Richard Stradling, Where the River tries, May 26, 1965, in Box 23, Folder of a Black middle-class population in Cleveland Clinic Archives, Cleveland Burned: Carl Stokes and the Struggle to Save 4, Gottron Papers. the Hyde Park area. See Hirsch, Making Clinic, Beachwood, OH (hereafter re- Cleveland (Ithaca, NY: Cornell University 22. Richard Gottron, memorandum on the Second Ghetto, 170. In a study of the ferred to as “Grotton Papers”). Press, 2017), 49–54. On de-industrial- ization, see Thomas Sugrue, The Origins Hough riots, July 20, 1966, in Box 23, Black middle class in Cleveland, Todd 5. “Mayor’s Emergency Committee: of the Urban Crisis: Race and Inequality in Folder 6, Gottron Papers. Michney dubs such neighborhoods Final Report,” 13, August 23, 1966, in Postwar Detroit (Princeton, NJ: Princeton 23. Thomas Hatch, “Notes on Urban “surrogate suburbs.” See Todd Michney, Box 23, Folder 6, Grotton Papers. University Press, 1996); Robert Self, Renewal,” December 28, 1966, in Box Surrogate Suburbs: Black Upward Mobility and Neighborhood Change in Cleveland, 6. On this tradition, see Nishani Frazier, American Babylon: Race and the Struggle for 23, Folder 4, Gottron Papers; on the 1900–1980 (Chapel Hill, NC: Univer- Harambee City: The Congress of Racial Postwar Oakland (Princeton, NJ: Princ- context of the Watts riot, see “Black sity of North Carolina Press, 2017), Equality in Cleveland and the Rise of Black eton University Press, 2003); Judith Stein, Community Transformation in the esp. 178–255. Power Populism (Fayetteville, AR: Univer- Running Steel, Running America: Race, 1960s and 1970s” in Josh Sides, L.A. sity of Arkansas Press, 2017); Kimberley Economic Policy, and the Decline of American City Limits: African American Los Angeles 35. Hatch, “The Fairfax Community,” Phillips, Alabama North: African-American Liberalism (Chapel Hill, NC: University From the Great Depression to the Present June 5, 1969, in Folder “Mayor Stokes’ Migrants, Community, and Working-Class of North Carolina Press, 1998); and Jef- (Berkeley, CA: University of California Plan” (semi-processed), Cleveland Activism in Cleveland, 1915–45 (Cham- ferson Cowie, Capital Moves: RCA’s 70- Press, 2003), 169–197. Clinic Archives. paign, IL: University of Illinois Press, Year Quest for Cheap Labor (Ithaca, NY: 24. Ibid. 36. Charles L. Hudson to Board of 1999). Cornell University Press, 1999). 25. Thomas Hatch to Richard A. Got- Governors, Cleveland Clinic, March 15. Thomas Hatch to Richard DeChant, 7. “Cleveland Citizens Committee on tron, memorandum on “Possible riots 27, 1967, in Folder “Mayor Stokes’ memorandum on “Phase II of the Uni- Hough Disturbances” (Exhibit 106), in 1967, and proposals to meet them,” Plan” (semi-processed), Cleveland versity-Euclid Urban Renewal Program.” October 13, 1966, in Federal Role in February 24, 1967; “For Discussion With Clinic Archives. Urban Affairs: Hearings Before the Sub- 16. Daniel R. Kerr, Derelict Paradise, Tom Hatch,” February 1967, in Box 23, 37. Moore, 170–172. committee on Executive Reorganization of Homelessness and Urban Development in Folder 6, Gottron Papers. the Committee on Government Operations, Cleveland, Ohio (Amherst, MA: Univer- 38. “Supplemental Information to 26. Ibid. United States Senate, Eighty-Ninth Con- sity of Massachusetts Press, 2011), 153. Document: Program for Consolida- gress, Second Session, Part 4 (Washington, See “A Note on Sources and Methods” 27. Thomas Hatch to J. H. Nichols, mem- tion-County Health Facilities,” April DC: US Government Printing Office, in Digital Scholarship Lab, “Renew- orandum on “Policies in re Community 15, 1971; Cuyahoga County Hospitals 1966), 1039–1046. ing Inequality,” American Panorama, Development,” September 6, 1968, in Planning Task Force, “Recommended Directions for Cuyahoga County Hos- 8. “Cleveland Citizens Committee ed. Robert K. Nelson and Edward L. Box 23, Folder 13, Gottron Papers. pital,” ca. April 1971 (from context) in on Hough Disturbances” (transcripts; Ayers, https://dsl.richmond.edu/pan- 28. On Stokes generally, see Leonard Series 24 NG1, Box 3, Folder 4, Papers microfilm), 75–86, August 23, 1966, in orama/renewal/#view=0/0/1&viz=ca Moore, Carl B. Stokes and the Rise of of Samuel Whitman, Case Western Re- Social Sciences Department, Cleveland rtogram (accessed February 10, 2018); Black Political Power (Urbana, IL: Univer- serve University Archives, Case Western Public Library, Cleveland, OH. Housing and Home Finance Agency, sity of Illinois Press, 2002). Urban Renewal Project Characteristics Reserve University, Cleveland, OH. 9. Martin Luther King Jr, Where Do (Washington, DC: Urban Renewal Ad- 29. Todd Swanstrom, The Crisis of 39. Carl Wasmuth to Henry Manning, We Go From Here?: Chaos or Commu- ministration, 1964), 44. Growth Politics: Cleveland, Kucinich, and the memorandum on Cleveland Clinic role nity (Boston, MA: Beacon Press, 2010 Challenge of Urban Populism (Philadelphia, in East Side health center, September [1968]), 119. 17. Thomas Hatch to Richard PA: Temple University Press, 1985), 100– DeChant, memorandum on “Phase 6, 1973, in Folder “68.00-000” (unpro- 10. Plans and Policies for Future Develop- 107; Carl Stokes, Promises of Power: A II of the University-Euclid Urban cessed), Cleveland Clinic Archives; Henry ment of Western Reserve University School Political Autobiography (New York, NY: Renewal Program”; Cleveland Clinic Manning, memorandum on “Negotia- of Medicine and University Hospitals of Simon and Schuster, 1973). meeting with Ralph Locher and tions with Cleveland Clinic Foundation Cleveland (Cleveland, OH: Committee Cleveland City Council, January 11, 30. Moore, 83–91. for Construction and Operation of an on Plans and Development, 1954), East Side Ambulatory Care Center,” June 1965, in Box 23, Folder 3, Gottron 31. Richard Gottron, “Plan for a Com- 46–48, 71–72, in Cleveland Health 18, 1973, in Folder “68.00-000” (unpro- Papers; Thomas Hatch, daily journal munity Health Facility,” June 7, 1968 Sciences Library, Allen Memorial Library, cessed), Cleveland Clinic Archives. entries, February 8 and February 10, (from context), in Box 23, Folder 9, Case Western Reserve University. 1965; Thomas Hatch to Richard A. Gottron Papers; Fay A. LeFevre to 40. “East Side Ambulatory Care Cen- 11. John D. Clough, ed., To Act as a Unit: Gottron, March 4, 1965, in Box 23, Glenn Wilson, August 12, 1968, in ter,” memorandum on status of Fairfax/ The Story of the Cleveland Clinic, 4th ed Folder 3, Gottron Papers. Folder “Mayor Stokes’ Plan” (semi- East Side project, ca. mid-1970s (from (Cleveland, OH: Cleveland Clinic Foun- 18. Samuel K. Roberts Jr, Infectious Fear: processed), Cleveland Clinic Archives. context) in Folder “3-PR20 Community dation, 2004), 221. Politics, Disease, and the Health Effects of Seg- 32. “Support Cleveland: NOW!,” ca. Relations – Clement Center” (semi- 12. Thomas Hatch to Richard DeChant, regation (Chapel Hill, NC: University of 1968 (from context); Richard Gottron processed), Cleveland Clinic Archives. memorandum on “Phase II of the Uni- North Carolina Press, 2009), 214. On the to Cleveland Clinic employees, May 41. Thomas Hatch to J. H. Nichols,

versity–Euclid Urban Renewal Program,” public health enterprise’s complicity in 24, 1968, in Box 23, Folder 8, Gottron memorandum on “Euclid-105th

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Business District,” January 9, 1968; Molotch, Urban Fortunes: The Political [Neighborhood]” (semi-processed), 52. Dan Diamond, “How the Cleve- Thomas Hatch to J. H. Nichols, Economy of Place (Berkeley, CA: Univer- Cleveland Clinic Archives. land Clinic Grows Healthier While memorandum on “Ingleside Hospi- sity of California Press, 1987), 50–98; Its Neighbors Stay Sick,” Politico, July 48. Office of Public Affairs, “The Cleve- tal & Euclid-East 105th Street Area,” “The Neighborhood Movement Falters” 7, 2017. land Clinic Foundation: Community November 14, 1968, in Box 23, Folder and “The Coalition Restabilizes” in Impact Report,” 3. 13, Gottron Papers; “Willis Arrested in Clarence Stone, Regime Politics: Governing 53. Michael B. Katz, Why Don’t American Harassment of Clinic,” Cleveland Plain- Atlanta, 1946–1988 (Lawrence, KS: Uni- 49. Henry D. Ziegler to William Kiser, Cities Burn Often? (Philadelphia, PA: Dealer, July 16, 1977, 8-A; William F. versity Press of Kansas, 1989), 108–159; November 30, 1984, in Folder “3- University of Pennsylvania Press, 2012), Miller, “Doans Corners: E. 105th St. “A Critique of Neoprogressivism in PR20 Community Relations – Clem- 78–100. ent Center” (semi-processed), Cleve- Area Struggles to Rise,” Cleveland Plain- Theorizing About Local Development 54. See, for example, recent traction land Clinic Archives. Dealer, January 10, 1982, 25-A, 31-A. Policy: A Case From Atlanta,” in Adolph around “structural competency” Reed, Stirrings in the Jug: Black Politics in 42. Fred McGunagle, “Cleveland 50. Henry D. Ziegler to William training for medical professionals. the Post-Segregation Era (Minneapolis, MN: Clinic: Service to Community Is New,” Kiser, November 30, 1984; “Min- Jonathan Metzl and Helena Hansen, University of Minnesota Press, 1999). Cleveland Press, February 28, 1976, utes of the Meetings of the Board “Structural Competency: Theorizing A1–A2; “Agreement Between the 46. Robert D. McCreery, James E. of Governors,” January 14, 1987, in a New Medical Engagement With Cleveland Clinic Foundation for the Burnett, and William H. Bryant, “Pro- Folder “3-PR20 Community Stigma and Inequality,” Social Science Cuyahoga County Hospital for the posal to the Cleveland Foundation for Relations – Clement Center” and Medicine 103 (2014): 126–133; East Side Ambulatory Care Center,” ca. Funding a Program to Cause Further (semi-processed), Cleveland Clinic and Mary Bassett, “#BlackLives- 1975 (from context), in Folder “68.00- Development of Cleveland as a Health/ Archives; Henry D. Ziegler to Wil- Matter—A Challenge to the 000” (unprocessed), Cleveland Clinic Medical and High Technology Center,” liam Kiser, December 24, 1986, in Medical and Public Health Archives. May 11, 1979, in Box 19, Folder 551, Folder “3-PR20 Community Communities,” New England Jour- University Circle Incorporated Papers, Relations – Clement Center” nal of Medicine 372, no. 12 (2015): 43. “East Side Ambulatory Care Center,” Western Reserve Historical Society, (semiprocessed), Cleveland Clinic 1085–1087. memorandum on status of Fairfax/East Cleveland, OH. Archives. Side project. 55. See “The Planning and Devel- 47. George Voinovich to Richard Taylor, 51. “Oversight on Financially Dis- opment of a Health Maintenance 44. “Who Pays for Care of Poor? Not memorandum on Cleveland Clinic role tressed Hospitals: Hearing Before the Organization at the Cleveland the Clinic,” Cleveland Press, February in East Cleveland development, March Subcommittee on Health and Scien- Metropolitan General Hospital,” De- 28, 1976, A-2. 23, 1982; Office of Public Affairs, “The tific Research of the Committee on cember 1, 1972, in Cleveland Health 45. Excellent analyses of city politics Cleveland Clinic Foundation: Commu- Labor and Human Resources” (Wash- Sciences Library, Allen Memorial in this era include “City as Growth nity Impact Report,” July 1982, in ington, DC: US Government Printing Library, Case Western Reserve Machine” in John Logan and Harvey Folder “3-PR20 Community Relations Office, 1980), 71–72. University.

1502 Public Health Then and Now Peer Reviewed Chowkwanyun AJPH November 2018, Vol 108, No. 11