Page 51 - 1619 Project Curriculum

August 18, 2019

The smallpox virus hopscotched One of the most eloquent rejoin- the disbursement of funds and could developed a countermessage: Health

across the post-Civil War South, ders to the theory of black extinction segregate resulting facilities. care was a basic human right.

invading the makeshift camps came from Rebecca Lee Crumpler, Professional societies like the Medicare and Medicaid were part

where many thousands of newly the nation’s first black female doctor. American Medical Association of a broader plan that finally brought

freed African-Americans had taken Crumpler was born free and trained barred black doctors; medical the legal segregation of hospitals to

refuge but leaving surrounding and practiced in Boston. At the close schools excluded black students, an end: The 1964 Civil Rights Act

white communities comparatively of the war, she joined the Freedmen’s and most hospitals and health clin- outlawed segregation for any entity

unscathed. This pattern of affliction Bureau and worked in the freed peo- ics segregated black patients. Feder- receiving federal funds, and the new

was no mystery: In the late 1860s, ple’s communities of Virginia. In al health care policy was designed, health care programs soon placed

doctors had yet to discover viruses, 1883, she published one of the first both implicitly and explicitly, to every hospital in the country in that

but they knew that poor nutrition treatises on the burden of disease in exclude black Americans. As a result, category. But they still excluded mil-

made people more susceptible to black communities. ‘‘They seem to they faced an array of inequities — lions of Americans. Those who did

illness and that poor sanitation con- forget there is a cause for every ail- including statistically shorter, sicker not fit into specific age, employment

tributed to the spread of disease. ment,’’ she wrote. ‘‘And that it may be lives than their white counterparts. or income groups had little to no

They also knew that quarantine and in their power to remove it.’’ What’s more, access to good medical access to health care.

vaccination could stop an outbreak care was predicated on a system of

in its tracks; they had used those very In the decades following Recon- employer-based insurance that was In 2010, the Aff ordable Care Act

tools to prevent a smallpox outbreak struction, the former slave states inherently diffi cult for black Ameri- brought health insurance to near-

from ravaging the Union Army. came to wield enormous congres- cans to get. ‘‘They were denied most ly 20 million previously uninsured

Smallpox was not the only health sional power through a voting bloc of the jobs that off ered coverage,’’ adults. The biggest beneficiaries

disparity facing the newly emanci- that was uniformly segregationist and says David Barton Smith, an emeri- of this boon were people of color,

at
pated, who at the close of the Civil overwhelmingly Democratic. That tus historian of health care policy many of whom obtained coverage

War faced a considerably higher bloc preserved the nation’s racial Temple University. ‘‘And even when through the law’s Medicaid expan-

mortality rate than that of whites. stratification by securing local control some of them got health insurance, sion. That coverage contributed to a
Despite their urgent pleas for assis- of federal programs under a mantra of as the Pullman porters did, they measurable decrease in some racial

tance, white leaders were deeply ‘‘states’ rights’’ and, in some cases, b couldn’t make use of white facilities.’’ health disparities, but the success
y

ambivalent about intervening. They adding qualifications directly to fed- In the shadows of this exclu- was neither as enduring nor as wide-

worried about black epidemics spill- eral laws with discriminatory intent. sion, black communities created spread as it might have been. Several

ing into their own communities and As the Columbia University histo- their own health systems. Lay black states, most of them in the former

wanted the formerly enslaved to be rian Ira Katznelson and others have women began a national community Confederacy, refused to participate

healthy enough to return to planta- documented, it was largely at the health care movement that included in Medicaid expansion. And sever-

tion work. But they also feared that behest of Southern Democrats that fund-raising for black health facili- al are still trying to make access to

free and healthy African-Americans farm and domestic workers — more ties; campaigns to educate black the program contingent on onerous

would upend the racial hierarchy, than half the nation’s black work communities about nutrition, sani- new work requirements. The results

the historian Jim Downs writes in force at the time — tation and disease prevention; and of both policies have been unequiv-
were excluded

his 2012 book, ‘‘Sick From Freedom.’’ from New Deal policies, including programs like National Negro Health ocal. States that expanded Medicaid

Federal policy, he notes, reflect- the Social Security and Wagner Acts Week that drew national attention saw a drop in disease-related deaths,

ed white ambivalence at every turn. of 1935 (the Wagner Act ensured to racial health disparities. Black according to the National Bureau of

Congress established the medical the right of workers to collective doctors and nurses — most of them Economic Research. But in Arkan-

division of the Freedmen’s Bureau — bargaining), and the Fair Labor trained at one of two black medical sas, the first state to implement work

the nation’s first federal health care Standards Act of 1938, which set a colleges, Meharry and Howard — requirements, nearly 20,000 people

program — to address the health cri- minimum wage and established the established their own professional were forced off the insurance plan.

sis, but officials deployed just 120 or eight-hour workday. The same voting organizations and began a concerted One hundred and fifty years

so doctors across the war-torn South, bloc ensured states controlled cru- war against medical apartheid. By the after the freed people of the South

then ignored those doctors’ pleas cial programs like Aid to Dependent 1950s, they were pushing for a federal first petitioned the government for

for personnel and equipment. They Children and the 1944 Servicemen’s health care system for all citizens. basic medical care, the United States

erected more than 40 hospitals but Readjustment Act, better known as That fight put the National Med- remains the only high-income coun-

prematurely shuttered most of them. the G.I. Bill, allowing state leaders ical Association (the leading black try in the world where such care is
White legislators argued that to eff ectively exclude black people. medical society) into direct conflict not guaranteed to every citizen. In

free assistance of any kind would In 1945, when President Truman with the A.M.A., which was opposed the United States, racial health dis-

breed dependence and that when it called on Congress to expand the to any nationalized health plan. In the parities have proved as foundational

came to black infirmity, hard labor nation’s hospital system as part of late 1930s and the 1940s, the group as democracy itself. ‘‘There has never

was a better salve than white med- a larger health care plan, Southern helped defeat two such proposals been any period in American histo-

icine. As the death toll rose, they Democrats obtained key conces- with a vitriolic campaign that informs ry where the health of blacks was

developed a new theory: Blacks sions that shaped the American present-day debates: They called the equal to that of whites,’’ Evelynn

were so ill suited to freedom that medical landscape for decades to idea socialist and un-American and Hammonds, a historian of science at

the entire race was going extinct. come. The Hill-Burton Act provid- warned of government intervention Harvard University, says. ‘‘Disparity

‘‘No charitable black scheme can ed federal grants for hospital con- in the doctor-patient relationship. is built into the system.’’ Medicare,

wash out the color of the Negro, struction to communities in need, The group used the same arguments Medicaid and the Affordable Care

change his inferior nature or save giving funding priority to rural areas in the mid-’60s, when proponents of Act have helped shrink those dis-

him from his inevitable fate,’’ an (many of them in the South). But it national health insurance introduced parities. But no federal health policy

Ohio congressman said. also ensured that states controlled Medicare. This time, the N.M.A. yet has eradicated them.•
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Photograph by D’Angelo Lovell Williams