When the Great Depression struck, the health department faced a growing demand for services with less money to provide them. With declining tax revenue, the county struggled to meet the need. Then, in 1938 the county got federal assistance under the Social Security Act of 1936 to establish the Multnomah County Health Division, drastically expanding its coverage.
With the United States’ entry into World War II on Dec. 7, 1941, local public health was again tested. Thousands of workers flocked to the Portland area to build ships for the war effort. As the city’s population ballooned to more than 350,000, people crowded into marginal housing Poor treatment of people of color and their segregation to wartime housing projects brought new health concerns, changing the mission of the county to encompass social change and mental health.
During this time, the Health Department continued to make strides in treatment of communicable and venereal diseases. At this point, the county was operating hospitals for the indigent and those in prolonged recovery. Finally, by 1955, the Health Department’s boasted programs in vital statistics, sanitation, tuberculosis control, school health, communicable diseases, infant and child health, venereal disease control, and mental health care.