Cultural & Ethnic Studies Critical Issues in African American Health, by Kevin McQueeney

450 Chapter 18 Critical Issues in African American Health Kevin University of New Orleans INTRODUCTION A deep connection between the field of medicine and the overall treatment and perception of African American extends back to the founding of this country . Proponents used ideas about the natural inferiority of Blacks to justify racism and slavery . In turn , these same forces led to a health poor care from the medical field and higher rates of serious health persist in the present . African Americans have also faced lasting barriers in gaining employment and professional recognition in the healthcare field . From the origins and continuation of health inequality to the fight to gain access to professional medical treatment , African American health and healthcare in history are interrelated issues . African American physicians , dentists , and nurses along with Black medical schools and hospitals have done pioneering work . While traditionally receiving less attention than issues like voting , housing , and education , the African American fight for healthcare is an important component of the Black freedom struggle , and a key aspect for understanding the current state of Black Americans . BLACK HEALTH IN EARLY HISTORY African American health is inextricably linked to slavery . Physician and scholar Rodney Hood argues that health disparity can be traced back to the period of slavery and the origins of racism , an effect he calls the slave health deficit . The enslavement of millions of African Americans had severe and lasting health impacts , both during the period of

451 slavery and The initial period of enslavement may have been the most lethal . Historians estimate that as many as 50 of Africans died before leaving the continent , during capture , the forced march to slave holding areas , or waiting in Somewhere between died during the Middle Passage across the Atlantic from the fifteenth through the nineteenth The mortality rate varied by place of origin , conditions in captivity and on the ship , and the point of destination . As many as died during capture , captivity , or transportation to this Of the Africans who made it to the , an additional died in the period between arrival and sale , and as many as 25 perished during the acclimation period of their first eighteen months as they adjusted to new locations , climates , and Enslaved individuals suffered from significant health problems . The Black infant and childhood mortality rate was double the rate for Whites . Over half of all Black children were born severely underweight due to the poor treatment and lack of nutrition for pregnant slaves many women miscarried or gave birth to stillborn babies . On average , Black mothers could nurse for only four months , compared to eight months for White babies . Early weaning , horrid living conditions , and lack of nutrition led to more than 50 of Black infants dying before the age of Poor health continued into adulthood . A supply of food resulted in protein hunger and deficiencies in thiamine , niacin , calcium , Vitamin , and Rodney Hood , The Health Deficit The Case for Reparations to Brin Health Parity to African Americans , Journal of the National Medical Association , 2001 ) William and Linda Clayton , An American Heath Dilemma A History of Blacks in the Health System , Journal of the National Medical Association , 84 ( 1992 ) and Clayton , An American Health Dilemma . Louis Gates , How Many Slaves Landed in the , The Root , January , Herbert Klein , Robin Haines , and Ralph , Transoceanic Mortality he Slave Trade in Comparative Perspective , Mary Quarterly , January 2001 ) 13 Herbert Klein , The Atlantic Slave Trade ( Cambridge Cambridge University Press , 1999 ) 178 . Steven , Childhood and Transatlantic Slavery , in Children and Youth in History , Item 57 , accessed January , 2018 .

452 The cramped and poorly constructed slave cabins , contaminated water sources , and harsh working conditions exacerbated malnutrition , leading to higher susceptibility to disease and developmental problems . Many enslaved people suffered from rickets , bowed legs , dysentery , respiratory ailments , cholera , typhoid , worms , skin problems , dementia , blindness , seizures , and swollen The lack of keeping at many plantations makes it difficult to know exact numbers , but scholars estimate the average life expectancy for an enslaved individual came to only years , compared to years for White during the antebellum Mortality rates varied by location and by the type of plantation enslaved people died at higher rates on sugar and rice plantations than on The field of medicine both justified the poor treatment of African Americans and contributed to their health problems . Building on the writings of White intellectuals going back to at least the Greeks , leading American scientists and physicians categorized African Americans as biologically inferior and less intelligent , or even . By the early , proponents of slavery used this argument to justify slavery . Defenders of slavery further argued that Africans were more genetically predisposed to work in the fields than Whites . Thomas Jefferson advocated this position in his influential Notes on the State of a ( 1805 ) While he concluded that enslaved Africans were inferior to the Whites in the endowments both of body and mind , he argued that they possessed some qualities that made them genetically designed to labor , notably that they seem to require less sleep and were more tolerant of heat . Physicians perpetuated the belief that Africans also had resistance or immunity to diseases like yellow fever . Herbert Covey , can ve Herbal and Treatments ( Lexington Books , 2007 ) Robert William , Consent or Contract The Rise and Fall of American ( NY Norton , 1989 ) 137 . What was Life Like Under Slavery , Digital History , 2016 , accessed July 11 , 2009 . 10 Covey , African American Slave Medicine ,

453 Because of these views , African Americans did not receive proper healthcare . primarily cared about profit this , not benevolence , served as their main motivation to seek medical care for enslaved individuals . Owners wanted slaves to recover quickly to return them to labor . On plantations , few employed physicians . Instead , the master , his wife , an overseer , or even designated slaves provided care prescribed in home health Owners also focused on using medical knowledge to increase the birth rate among the enslaved population . Buyers placed great emphasis on the perceived fertility of females , in the hopes that these women would give birth to children that would be considered the slave owner usually called for a physician only as a last resort , and racist attitudes affected the care offered by White physicians . White doctors experimented on enslaved individuals in pursuit of medical advances due to their beliefs that Blacks were inferior and had higher tolerances of pain . These doctors sought no consent from the enslaved but instead from the slave owner . Physicians applied this gained knowledge to benefit the White The inequality in access to healthcare and the poor treatment by physicians in this period marked the beginning of a healthcare system based on racial discrimination . The view of African Americans as inferior and less worthy meant that few received proper medical care for curable afflictions . In some ways , free Blacks faced worse healthcare , with little access due to high rates of poverty and physicians who refused to treat Black patients . A healthcare greater access and treatment for persisted for much of American history . Due to this neglect , enslaved individuals provided care for themselves . They used folk medicine they had learned in Africa before including Cesarean birthing and inoculation for from other enslaved members , passed down orally . Black women predominantly served in this role and functioned as midwives for fellow slaves and even White women . For many African 11 Covey , African American Medicine , 36 . 12 William and Linda Clayton , Race , Medicine , and Healthcare in the United States A Historical Survey , Journal of the Medical on , March 2001 ) 13 Ibid .

454 Americans , medical treatment included and herbal remedies as well as spiritual elements like prayers , charms , songs , and conjuring , vestiges of African healing traditions . Even when White physicians were available , many preferred to use folk healers who offered more holistic and personalized care . Some herbal remedies worked , and even those that did not presented less potentially negative side effects than popular official remedies like bleeding or mercury . Although many Whites opposed Black medical example , South Carolina and Virginia passed laws in the century to prohibit the Southern plantation owners relied on Blacks to provide medical African Americans also used medical knowledge as a form of resistance . Some enslaved individuals feigned illness to purposely slow down work , get needed rest , or spend time with family . Unfortunately , slave owners often suspected slaves of making up illnesses even when truly sick , forcing the sick to work and punishing those they thought to be making up an In response to treatment of female slaves as breeders producing more enslaved individuals to work in the fields , some enslaved women used early forms of birth control or even abortion to prevent this and regain some form of control over their BLACK PHYSICIANS IN THE ANTEBELLUM PERIOD Some African Americans , both slave and free , learned medicine under an apprenticeship . For example , James was born in Philadelphia in 1762 . Serving as a assistant to a series of owners , bought his freedom in 1783 . established his own practice in New Orleans , treating White and Black patients . In 1788 , briefly returned to Philadelphia , where he befriended Benjamin Rush , a leading 14 Covey , African American Medicine , 43 . 15 Covey , African American Medicine , 38 . 15 Stephanie Camp , Closer to Freedom Enslaved Women and Everyday Resistance in the Plantation South ( Chapel Hill University of North Carolina Press , 2004 )

455 physician , Founding Father , and opponent of slavery . In speeches and letters in support of abolition , Rush held up as an example of the intelligence and capability of Blacks . moved back to New Orleans in 1789 , where he continued to practice medicine until at least 1802 . However , Spanish rules permitted him to treat only throat ailments after 1801 due to his lack of a formal medical degree . is believed to be the first Black physician in the United Some free Blacks went to medical school in Europe or at a small number of Northern colleges . Born in New York City in 1813 , James Smith became the first African American to earn a formal medical degree . The son of a woman who bought her freedom , Smith attended the city school for free Blacks . Denied admission to American colleges , Smith finished the University of Glasgow in 1837 . After an internship in Paris , he returned to New York City , set up his own practice , and became a leading African American intellectual and abolitionist . Smith helped found the National Council of the Colored People with Frederick and wrote the introduction to My Bondage and My Freedom . Smith also became the first African American published in a medical journal , and refuted ideas of racial A handful of others attended medical college in the United States . Born in Baltimore in 1815 , Samuel Ford moved with his family to in 1826 . He returned to the United States to attend medical school at Dartmouth College and graduated in 1839 . practiced in and trained other physicians in the David Peck became the first African American to receive a medical degree from an American medical Rush Medical College in 1847 he was also the first to practice in the United in Philadelphia , and then Pittsburgh , 17 Charles , James , Mysterious Black Physician Man or Myth , The Pennsylvania Magazine of History and Biography , July 1979 ) 13 Thomas Morgan , The Education and Medical Practice of James Smith ( First Black American to Hold a Medical Degree , Journal of the National , July 2003 ) 19 James Sims , George Seymour and Benjamin Anderson , Exploration in . Four Diaries ( Indiana University Press , 2003 ) 370 .

456 before moving to in 1852 . Like , abolitionists held up Peck as an example of the equal intellect of African After first working as a nurse for eight years , Rebecca Lee Crumpler became the first African American woman to complete a doctorate in medicine in 1864 . Crumpler worked in Richmond , care for recently freed individuals through the Freedmen ran a practice in Boston , Few African Americans had formal opportunities to receive medical training . Only a handful of medical colleges admitted Black students , and those who did graduate faced obstacles in practicing . Few physicians referred patients to Peck practice or recognized him as a doctor , for example , leading him to close after only two years . Most White patients refused to utilize a Black doctor . Despite these barriers , Black physicians served as intellectual and civic leaders in the Black community and played prominent roles in the abolition movements . THE CIVIL WAR African Americans played a significant role in the Civil War , including in healthcare . With many White physicians serving in the Confederate Army , plantation owners increasingly relied on enslaved folk medical practitioners for care . The South also used enslaved African Americans to treat wounded Confederate Hundreds of thousands of African Americans fled during the war , leading to a major health crisis . The Army created refugee camps as it traveled . Housing was quickly constructed and of poor quality , as were food sources and sanitation . Thousands died of , in Michael Harris , David Jones Peck , A Dream Denied , Journal of the National , 1996 ) 21 National Library of Medicine , Rebecca Lee Crumpler Biography , National Institute of Health , 2013 , last accessed July 11 , 2019 . 22 Covey , African American ve Medicine , 46 .

457 hunger . Despite the harsh conditions , over Black refugees lived in refugee camps in , Mississippi Memphis , Tennessee New , North Carolina and elsewhere . They provided invaluable services for the army as soldiers , teamsters , nurses , and seamstresses , and created new lives in In Washington , the Union Army built the Contraband Hospital as part of a refugee camp on the of the city . Like other camps , overcrowding , poor living conditions ( most lived in tents even during the winter ) and limited food and water ( only one well supplied the entire camp ) caused many to become sick . The hospital provided care for camp inhabitants . At first , the hospital staff was primarily White , but in May 1863 , Alexander African the . After August appointment , Black doctors increasingly staffed the hospital , working with Black nurses mostly drawn from the camp residents . The government closed the camp in December 1863 , but continued the hospital , moving it several times , before eventually becoming the Freedmen Hospital with a permanent home on Howard campus in 1868 . In all its various locations , Black nurses and doctors trained at the hospital , and then went to work at other hospitals or their own The Freedmen Bureau set up hospitals like the one in in other states , with a peak of 45 in 1867 . These hospitals provided care for tens of thousands , many of whom had never before received professional medical treatment . However , these institutions suffered from a lack of funding , low salaries that made hiring difficult , and poor building conditions . When the Freedmen Bureau ended in 1872 , only the Freedmen Hospital in remained 23 Jim Downs , Freedom ) Illness and during the Civil War and Reconstruction ( Oxford Oxford University Press , 2012 ) 95 . 24 Jill , Contraband Hospital , Health Care for the First , 2017 , last accessed July 11 , 2019 . 25 Vanessa Gamble , Making a Place for Ourselves The Black Hospital Movement , Oxford Oxford University Press , 1995 )

458 Black Health and Healthcare After the Civil War Poor health continued to afflict African Americans in the war aftermath . At least one million suffered or died from diseases like Due to high rates of poverty , many could not afford proper medical care , and those who could , experienced discrimination from predominantly White physicians . This poor treatment , plus the history and continued experimentation on Black bodies by White doctors , resulted in a lasting distrust of the medical field . As a result , many Black Americans still relied on Black folk practitioners and Health problems had other significant effects that affected future generations . On top of other issues like racial discrimination , health problems made it difficult to acquire land and wealth , and prevented mobility . Even after the war , many African Americans remained stuck in the South over 90 of African Americans still lived in the South at the end of the nineteenth century ?

After the Civil War , African Americans made some gains in the medical field . The son of former slaves , Robert Tanner Freeman became the first African American to graduate with a doctorate in dental surgery . Freeman apprenticed under a White dentist , and after an initial rejection from Harvard , which refused to admit Black students , he and another Franklin admitted to Harvard Dental School in 1867 . Freeman graduated in 1869 and set up a practice in his home city of Washington , Freeman classmate , Grant , became Harvard first Black faculty member . Grant was a pioneer in the care of patients with congenital cleft palates , patenting a device that allowed patients to speak Ida Gray Nelson Rollins became the first female African 25 Downs , Freedom . 27 and Clayton , Race , Medicine , and Healthcare in the United States , 319 . 28 . Logan , Health , Human Capital , and African American Migration Before 1910 , Explorations in Economic History , 2009 ) 29 Winston Benjamin , Robert Tanner Freeman , 2017 , 73 , last accessed July 11 , 2019 . Chris Ott , George Franklin Grant , 2017 , last accessed July 11 , 2019 .

459 American doctor of dentistry , graduating from the Ohio College of Dentistry in 1890 and practicing in Cincinnati and However , most medical schools still refused to admit Black students . As a result , several Black medical colleges originated , starting with Howard University medical department in 1868 . Most of these schools were affiliated with missionary organizations like the American Missionary Association , received little funding , and employed few By the , over nine hundred Black physicians held medical degrees and practiced in the United States , serving a population of million African Graduates of these programs still faced major obstacles in gaining professional experiences and acceptance . Founded in 1847 , the American Medical Association was the most prestigious organization in the medical profession . Local chapters determined membership , and almost all refused to admit Black physicians . This resulted in the denial of lectures and trainings . In response , a Black equivalent of the National Medical in 1895 . Similarly , in 1908 the National Association of Colored Nurses started . Additionally , most White hospitals refused to hire Black doctors . Almost all required AMA membership for employment , effectively barring African Americans . In the late nineteenth century , many Southern states formally segregated public hospitals , and private hospitals voluntarily followed suit . Hospitals refused to hire Black physicians and treated Black patients only in separate wings or different buildings . Facing discrimination from White hospitals as both patients and physicians , African Americans began their own hospitals . In 1891 , a group of Black physicians founded the Provident Hospital and Training School Association in Chicago , the first 31 Ag bor , Ida Gra Nelson Rollins , 2017 , last accessed July 11 , 2019 . 32 Todd , Abraham and the Black Medical Schools , in and , Beyond Medical Education in the Century ( NY Greenwood Press , 1992 ) 33 Herbert Ruffin , Daniel Hale Williams , 2017 , last accessed July 11 , 2019 .

460 hospital in the nation . Provident also held several other distinctions it had the first interracial staff , offered the first training space for Black nurses , and was the site of one of the earliest surgeries in 1893 . Black hospitals throughout the primarily in the by 1919 , one hundred and eighteen Black hospitals existed . During that same period , the number of Black nurses grew significantly as well , greatly aiding the proliferation of Black hospitals . College opened the first Black nursing school in Numerous problems hampered Black hospitals though . Due to high Black poverty rates , hospitals collected little money in patient fees , and Black hospitals usually did not receive funding from state or local governments . The lack of government aid forced these institutions to rely on donations and fundraising campaigns and to endure continuous money shortages . Financial problems made expansion extremely difficult , limiting the number of patients who could be served and preventing improvements in medical equipment and building facilities . This latter condition led to constant issues with licensing inspections . Black hospitals also faced staffing problems . Very few White medical schools admitted African Americans , and only seven Black medical colleges existed by 1910 . Like hospitals , these schools faced funding problems . In 1904 , the American Medical Association created the Council on Medical Education ( CME ) to study and standardize medical education . The CME asked the Carnegie Foundation to fund a study , led by Abraham , of all medical colleges in the United States . Of the seven Black medical schools in existence at the time of the Report ( 1910 ) the five colleges named in the report as inadequate all closed in the following thirteen years . Only Howard University and College maintained their medical schools , and another Black medical college did not open until the Charles Drew Medical School in Los Angeles started in 1966 . During that period , the number of Black physicians , which had increased steadily in the prior period , 34 Gamble , Making a Place for Ourselves , 35 , Abraham and the Black Medical School , 1420 .

461 The of Black physicians made staffing hospitals difficult , especially in the South . Oppressed by segregation , many Black doctors left the South as part of the Great Migration . Some African American leaders also openly criticized Black hospitals , arguing that their existence helped to support segregation proponents of segregation could point to Black hospitals as justification for not integrating public hospitals . Defenders of Black hospitals highlighted the great need for the institutions and the biracial staffs as examples of cooperation hospitals like Provident and Flint in New Orleans had White patients in the and early , although this largely ceased as segregation increased and the color line Even though many faced great professional discrimination , Black doctors served as leading medical pioneers in the first half of the twentieth century . In 1897 , Solomon Carter Fuller graduated from the Boston University School of Medicine and became the nation first Black psychiatrist . He worked at the State Hospital in Boston and served as a faculty member at his alma mater . After working with at the Royal Psychiatric Hospital in Munich , in 1912 Fuller published the first major study of disease in the Others too made major contributions Louis Wright developed the intradermal injection for smallpox vaccination in 1917 William August created the Test for the diagnosis of syphilis in 1936 and published the first medical textbook authored by an African American in 1938 and Charles Drew developed new techniques for the storage and of blood and plasma during World War The Black medical profession made significant advances in the first half of the twentieth century . The National Medical Association created the National Hospital 35 Gamble , Making a Place for Ourselves , 17 . 37 , Carter Fuller , 2017 , last accessed July 11 , 2019 . 38 Black History Month A Medical Perspective Chronology of Achievements , Duke University Medical Center Library Archives , 2016 , last accessed July 11 , 2019 .

462 Association in 1923 as part of its efforts to increase professionalization and standards and to prevent Black hospitals from closing . The improved training , held conferences , wrote recommendations on hospital administration , and published articles on Black medical advances in their journal . PUBLIC HEALTH Black hospitals and healthcare workers also tackled the major public health issues of the time . Tuberculosis ( Whites had a disease rate of per , compared to the Black disease rate of 202 per ) pneumonia ( White rate of per , compared to the Black rate of per ) and disease ( White rate of per , compared to Black rate of per ) contributed to a mortality rate twice as high , and a 62 higher infant mortality rate for Blacks as for Whites in the . The continued disparity in healthcare access greatly contributed to this inequality one hospital bed existed for every 139 White Americans , compared to one bed for every Black African American leaders played prominent roles in highlighting these issues and pushed forward to address Black public health problems . In 1906 , published The Health and Physique of the Negro American to counter the claims of White supremacists like Frederick Hoffman that the higher African American mortality rate was evidence of their natural inferiority . worked at the Prudential Life Insurance Race Traits and Tendencies of the American Negro in 1896 , in which he stipulated that African Americans were healthier during enslavement and would soon die out as a race . In his rebuttal , argued that the high death rate caused by diseases like tuberculosis resulted from African Americans higher rates of poverty , not from racial inferiority . All the evidence , noted , goes to show that it is not a racial disease but a social disease . He used as evidence demographic data 39 Gamble , Making a Place for Ourselves , 183 .

463 collected by the United States Census Bureau . further advocated that increasing the number of Black hospitals , physicians , and healthcare workers , and improved sanitation , education , insurance , and economic opportunities would lower the mortality rate . Finally , called for the creation of local health care leagues to take the lead in combating Black public health Head of the Institute in Alabama and perhaps the most influential Black American at the time , Booker Washington also addressed public health . Institute held a event each year at the school and in the surrounding community that focused on sanitation and public health . Washington urged residents to thoroughly clean and whitewash their homes and to make improvements to promote better health . The school also sponsored public health talks . Starting in 1912 , the Institute hosted a clinic during the health week , with physicians from throughout the country offering free medical Speaking in 1914 , Washington argued that 45 of Black deaths were preventable and African American serious illnesses cost the economy 100 million dollars annually . Washington called for a National Negro Health Week in 1915 . An oversight committee at the Institute made recommendations each year on what local committees should do and called for churches , schools , fraternal organizations , and other community groups to participate . The week focused on home sanitation education about tuberculosis and sexually transmitted infections , especially syphilis school health programs free clinics and neighborhood cleanups . The Public Health later controversially conducted the exploitative , syphilis study on Black men in , detailed later in this a in the . The weekly event turned into Robert , and Demography Early Explorations , Today , Spring 2009 ) last accessed July 11 , 2019 . 41 Negro Health Week , Journal of the National Negro Health Association , March 1947 )

464 activities and educational material known as the National Negro Health Movement , a program that existed until Recognizing that many African Americans could not afford medical treatment , some Black hospitals offered or free clinics for the indigent , and began providing their own insurance program for the . Flint Hospital in New Orleans was among the earliest , starting in 1936 . For dollars a year , patients were eligible for up to 21 days of hospitalization they could also add their spouse for a total of per couple , or all the children for a total of per family . By 1938 , over three thousand people enrolled . The American Medical Association endorsed the plan , and identified it as the cheapest in the nation , and Life Magazine hailed it as heartening inspiration during the Great Depression and Jim While free clinics , insurance programs , and public health initiatives led to improvements , African Americans still suffered higher rates of disease and death . The Great Depression further exacerbated these health problems , disproportionately affecting African Americans . It led to an increase in the Black poverty rate and a related decline in the number and financial stability of Black hospitals . The National Medical Association argued that a Black medical ghetto existed in the , with African American residents not receiving enough medical care and an insufficient number of Black hospitals to serve the large Some African American leaders sought federal health funding . They argued that even those that upheld Jim Crow should support this effort as improved Black health would be good for the nation economy . While pushing for federal aid , Black advocates often had to accept segregation rather than fight for integration in order to make some gains . In 1943 , the American Hospital Association ( AHA ) recommended that the federal government pass legislation to aid building of more hospitals . After lobbying by the AHA 42 Sandra Crouse Quinn and Stephen Thomas , The National Negro Health Week , 1915 to 1951 A Descriptive Account , Minority Health Today , 2001 ) 43 Claire Perry and George Sessions Perry , Penny a Day Hospital , The Saturday Evening , 1939 . 44 Gamble , Making a Place for Ourselves , 183 .

465 and a speech by President Truman calling for improved healthcare , Congress passed the Hospital Survey and Construction Act ( known as the Hill Burton Act ) in 1946 . The legislation made available federal funding for the expansion of existing hospitals and the construction of new ones , with the goal that each state would reach a quota of beds available per residents . Although a federal law , each state determined the allocation of funding . Furthermore , while the bill forbade racial discrimination , it permitted spending to support segregated facilities , as part of the separate but equal doctrine , until the Supreme Court struck down that provision in Most of the Hill Burton funding went to the South , as it was the region with the country greatest need . Although White hospitals received most of the support , some aid facilitated the building of new Black hospitals or improvements on existing ones . Other federally funded programs helped cities and states create new health departments and maternal and child clinics . While these federal programs provided aid , critics argued that like Black hospitals , segregated health programs continued to uphold Jim Crow and health MEDICAL EXPLOITATION Despite gains due to legislation , many African Americans remained distrustful of the government involvement in healthcare . In the early twentieth century , the government funded forced sterilization programs in 32 states for tens of thousands of women , primarily people of color . Originating in the late nineteenth century , the eugenics movement spread in the starting in the . Eugenics was based on the concept that selective breeding should be encouraged , with government involvement , to improve society . Supported by funding from leading organizations like the Carnegie and 45 Carla Smith , The Act A Basis for the Prevention of Urban Hospital Relocation , Indiana Law School , Summer 1980 ) 45 Karen Thomas , Jim Crow ' and American Cy ,

466 Rockefeller foundations , scientists from top universities carried out research that demonstrated supposed negative genetic traits of certain groups that should not be allowed to reproduce the mentally ill or disabled , those deemed sexually deviant , criminals , immigrants , the indigent , and minorities . Some doctors actively engaged in , killing patients or willfully neglecting until they Forced sterilization became the most mainstream manifestation of eugenics , with states adopting forced sterilization laws in the first decade of the twentieth century . Although masked as progressive reform ( to produce the most superior citizens and to reduce government spending on providing for the unworthy ) and supported by public health advocates , scientists , physicians , and politicians , forced sterilization was a product of racism and xenophobia . In many ways , proponents promoted forced sterilization similar to the ways they advocated residential segregation ( African Americans should be kept out of White neighborhoods to prevent the spread of disease ) or miscegenation ( interracial marriage and children would produce inferior , mixed race children , damaging to White purity ) The Nazis partially modeled their own policies of sterilization and in the and on American Eighteen Southern states adopted sterilization laws and often used them to target African American women . In 1964 , Mississippi Freedom Democratic Party leader Lou spoke of her own experience . In 1961 , underwent surgery in Mississippi for a uterine tumor . During surgery , and without her consent , the operating physician performed an unnecessary hysterectomy . highlighted the commonality of the procedure , which she dubbed a Mississippi appendectomy , and estimated that 47 Lisa Ko , Unwanted Sterilization and Eugenics Programs in the United States , Independent Lens , January 29 , 2016 . 43 Edwin Black , The Horrifying American Roots of Nazi Eugenics , History News Network , September 2003 , 1796 , last accessed July 11 , 2019 .

467 physicians at the hospital , without consent and with no medical need , sterilized approximately 60 of Black female HEALTHCARE AND CIVIL RIGHTS in the , the Black National Medical Association began to support the efforts of the and others to push for the integration of hospitals . Black civic leaders first targeted the Veterans Administration hospitals in 1945 , finally succeeding in integration of these federally funded hospitals in 1953 . Like other areas of civil rights , the push for medical equality proved extremely Most hospital nationwide remained segregated through the one 1956 study found segregation in 83 of hospitals in the North and 94 of hospitals in the South . While the Civil Rights Movement most prominently focused on the desegregation of schools and voting rights , activists also fought for health equality . Community health workers established their clinics in places like Mississippi where none existed for African Americans . Medical students pushed schools to serve nearby Black residents . Lawyers sued hospitals that violated the discrimination provision of the Hill Burton Act . Black physicians played prominent roles in the and other civil rights groups . For example , Howard , a surgeon and president of the National Medical Association , founded the Regional Council of Negro Leadership in 1951 , a civil rights organization , and rose to national fame for his involvement in the case of Emmett Till , murdered in 1955 . Physicians John and Walter Lee started the Medical Committee for Civil Rights in 1963 . The group picketed the annual American Medical Association convention that year in protest over the organization continued acceptance of discrimination by local chapters ( it would not formally bar racial exclusion until 1968 ) 49 Lou , Educational Foundation , 2018 , last accessed July 11 , 2019 . Gamble , Making a Place for Ourselves , 183 .

468 marched in the 1963 March on Washington and provided care during the Mississippi Freedom After years of advocacy and litigation , President Lyndon Johnson signed the Civil Rights Act of 1964 . Title VI of the bill mandated ineligibility for receiving any federal funds for any institution that discriminated against minorities . Congress followed up Title with the passage of the Social Security Amendments of 1965 , which included primarily health insurance for those 65 and for those with low incomes . Compliance by hospitals proved difficult as many resisted desegregation . Especially in the South , many hospitals either continued to employ only White doctors or hired a token number of Black physicians to avoid lawsuits . The made numerous complaints against hospitals for continuing to use segregated wards , water fountains , benches , and even telephones . The of Health , Education , and Welfare found in the that hospitals containing 58 of the nation beds ignored the statute , and the launched a campaign , supplemented by numerous lawsuits by civil rights groups , to force hospitals to integrate and end discrimination . However , although federal laws mandated that hospitals that violated the discrimination statutes should be denied federal funding , few hospitals received any punishment for offenses . Lawsuits against hospitals for discrimination against Black patients and in hiring Black physicians continued through the with little substantial changes . 52 Apartheid healthcare persisted . Many hospitals admitted little or no Black patients , and few admitted Medicare and Medicaid patients . Poor Black patients primarily remained at underfunded city or Black hospitals . Although Medicare and Medicaid allowed more indigent patients to receive hospital care , the cost of treatment typically exceeded the 51 Hoffman , The Medical Civil Rights Movement and Access to Healthcare ( National Library of Medicine , 2014 ) 52 Preston Reynolds , Professional and Hospital Discrimination and the US Court of Appeals Fourth Circuit , American Journal of Public Health , May 2004 )

469 compensation for treatment , leaving those hospitals financially struggling and affecting their quality of care . CONTINUED INEQUALITY While the immediate years after integration saw some health gains for African Americans , particularly for those who previously had no access at all , improvements largely stagnated after 1975 . Starting in the 19805 , Black morality began to increase again , and African American life expectancy declined . With White flight to the suburbs , Black residents were increasingly concentrated in urban cores with underfunded and In the face of continued health disparity , African American groups again provided their own medical services . Berry founded an organization named the Flying Black Medics . Sponsored by the Methodist Episcopal Church and local community groups , the group began flights in 1970 from Chicago to Cairo , Illinois , providing free medical care and supplies to poor African In the late , the Black Panther Party became involved in healthcare . The national organization required all chapters to provide health clinics due to continued health discrimination and inequality . The Panthers also launched a sickle cell anemia awareness campaign , providing education and free screening for the disease , which the organization felt was understudied and underfunded as it disproportionately affected African The Black Panther Party health program further reflected the distrust of medical institutions . As detailed earlier , physicians used enslaved African Americans for medical experiments . Hospitals and prisons continued this practice after slavery ended , and medical colleges stole African American cadavers for student training . Perhaps the most 53 and Clayton , Race , Medicine , and Healthcare in the United States , 319 . 54 Hoffman , The Medical Civil Rights Movement . 55 Nelson , Body and Soul The Black Panther and the Fight Against Medical Discrimination ( University of Minnesota Press , 2011 )

470 famous example of medical exploitation was the Experiment , started by the Public Health Service in 1932 . The program recruited 600 Black with syphilis , and 201 not a study on the effects of the disease . Administrators promised free medical treatment for participants . However , physicians did not inform the men of the purpose of the study and did not treat the individuals who had syphilis , even after penicillin was discovered as a cure in 1947 . In 1972 , the Associated Press reported on the story , leading to a public outcry and investigations . Recent research has demonstrated that the history of medical exploitation , particularly the Experiment , has led African Americans to be more distrustful of doctors and less likely to use healthcare services , contributing to the higher mortality In the , the increase in the Black mortality rate also corresponded with the decreased funding for hospitals that predominantly served the African American community . State aid declined dramatically , particularly with the economic recession . The number of Black hospitals rapidly plummeted as a result . From 1961 to 1988 , Black hospitals closed , including Chicago Provident Hospital , the first hospital in the CONCLUSION Health inequality persists in America . The Center for Disease Control and Prevention found that African Americans have a shorter life expectancy ( years ) than Whites ( African Americans suffer from higher rates of illness and health problems the estimates that of African Americans are in poor health compared to of Whites . The overall mortality rate has dropped for all races in the 55 Harriet Washington , Medical Apartheid The Dark History of Medical Experimentation on Black Americans from Colonial to the Present ( MA Anchor , 2008 ) 57 Mitchell Rice and Woodrow Jones , Public Policy and the Black Hospital From Slavery to Segregation to Integration ( Greenwood Publishing Group , 1994 ) 101 .

471 past two decades , driven by declining deaths from cancer , heart attacks , and strokes . However , African Americans still have a mortality rate 16 higher than Whites ( down from 33 in 1999 ) and are more likely to die at every age . The discrepancy is particularly notable in infant moI rate of per for Blacks and per for in maternal deaths with a rate of Black deaths per live births compared to White deaths per live Health inequality reflects multiple factors higher rates of unemployment , obesity , and poverty and lower rates of home ownership , education , and wealth . African Americans also continue to have less access to welfare under the age of 65 do not have healthcare , compared to of Whites . Researchers have also demonstrated that racial discrimination , including from the healthcare system itself , also negatively impacts Inequality continues in the medical profession , too . While making up 12 of the overall population , less than of physicians and surgeons are The roots of health inequality date back to the beginning of this country . Treated as racially inferior , neglected or excluded by White healthcare systems and as the victims of systematic and institutionalized racism and segregation , African Americans have suffered higher rates of disease and mortality than White Americans throughout this country history . African Americans have fought for increased access provided care for themselves in various forms , from enslaved midwives to Black hospitals and made important contributions to the medical field . However , the historical vestiges of a tiered healthcare system remain as deeply entrenched as other aspects of structural racism . Discussion Questions . What is the slave health deficit and how has it persisted ?

53 Health , United States , 2016 With on Trends in Health ( National Center for Health Statistics , 2017 ) 59 Ibid . Joseph Williams , Why America Needs More Black Doctors , News World , August 31 , 2018 .

472 . What barriers have historically prevented African Americans from becoming physicians ?

How have African Americans provided healthcare for themselves ?

What changes could be made to the healthcare system to increase African American access ?

Writing Prompt Studies have found that African Americans are much less likely to trust physicians , hospitals , and the healthcare system . As a result , they are also less likely to seek treatment , contributing to higher mortality rates . Many attribute this distrust to historical episodes of medical exploitation like the Experiment . Others highlight the history of racism and discrimination by healthcare providers . Taking a historical perspective , what do you believe has contributed to this mistrust ?

What can be done to address this issue and improve trust in healthcare ?