An American Health Dilemma

Race, Medicine, and Health Care in the United States 1900-2000

W. Michael Byrd, Linda A. Clayton

• Publisher: Routledge
• Year: 2001
• ISBN:
  9781136600302
• Edition: 1
• Topic: Media & Performing Arts
• Subtopic: Theatre

First published in 2002. An American Health Dilemma is the story of medicine in the United States from the perspective of people who were consistently, officially mistreated, abused, or neglected by the Western medical tradition and the US health-care system. It is also the compelling story of African Americans fighting to participate fully in the health-care professions in the face of racism and the increased power of health corporations and HMOs.

This tour-de-force of research on the relationship between race, medicine, and health care in the United States is an extraordinary achievement by two of the leading lights in the field of public health. Ten years out, it is finally updated, with a new third volume taking the story up to the present and beyond, remaining the premiere and only reference on black public health and the history of African American medicine on the market today. No one who is concerned with American race relations, with access to and quality of health care, or with justice and equality for humankind can afford to miss this powerful resource.

Foreword to Volume One

This book represents an extraordinary achievement by the authors, who have brought together in two volumes the history of the African American health experience in the United States and its broader historical perspective.

In particular, An American Health Dilemma: A Medical History of African Americans and the Problem of Race documents in the most detailed manner how, from the nation’s earliest period, the African American population suffered severely from years of slavery, racial discrimination, segregation of health care facilities, denial of health professional education opportunities and gross under-funding of those opportunities that existed, and neglect of the most elementary health needs of their community. It traces, through successive generations, the major barriers that prevented African Americans from receiving the most basic medical care and public health services, and examines the resulting high rates of death, disability, and human suffering.

Of additional importance, this book is the first to chronicle in such detail the courage, leadership, ingenuity, and scientific and professional skills of generations of individual African American physicians and other health professionals who struggled against great odds to build a responsive health system that would meet the needs of those living in a segregated society, often in great poverty.¹ It also highlights many of the important and heretofore unrecognized contributions made by a diverse group of African American pioneers to the broader world of medical treatment and biomedical science.

This series is of such significance because it seeks to explain and document the historical factors behind today’s huge disparities in the level of health between Whites and African Americans.² The fact that African Americans today live substantially shorter lives than Whites; die more frequently from cancer, heart disease, stroke, and diabetes; and see their infants die at nearly twice the rate of Whites is in part a result of their unique and tragic historical experience in America. Growing from this, African Americans today also remain less likely than Whites to have health insurance coverage and less likely to be treated by a physician when they are ill.

The need for this book grows from the understanding that these health disparities and their historical antecedents are not well recognized by the majority of Americans, particularly White Americans. In fact, beliefs today are almost the opposite of the reality portrayed in this work. Surveys show that the majority of White Americans believe that discrimination, past and present, is not a major reason for the social and economic problems African Americans face today.³ They also show that most Whites are not aware that African Americans have a shorter life expectancy, a higher rate of infant mortality, more problems with access to health care, and a higher rate of being uninsured than Whites.⁴ It is my hope that these two volumes will become textbooks in classrooms across the country and will help bridge this wide gap in knowledge of the extent of African American health problems and their roots.⁵ These volumes should also serve as important texts for minority students seeking greater understanding of the many contributions made by leaders of the African American medical community across many centuries. If not for the publication of these volumes, many of those extraordinary health care achievements would have remained unknown even to those most concerned with these issues.

The bringing together of this huge body of work about the history of the African American health care experience in the United States required years of dedicated research under difficult circumstances. We are all indebted to W. Michael Byrd, md, and Linda A. Clayton, md, for their devoted commitment to bringing this history to the broader health and medical community. I hope their effort will result in a movement in this nation to provide the African American population with a more responsive and caring health system in the new century.

I am very pleased and privileged that this important work was conducted under the auspices of the Department of Health Policy and Management and the Division of Public Health Practice of the Harvard School of Public Health.

ROBERT J. BLENDON, SC.D.
Professor of Health Policy and Political Analysis
Harvard School of Public Health and the Kennedy School of Government

References

1. Cunningham RM Jr. Discrimination and the doctor. Medical Economics 1952; 29(1): 119-124. 2.

2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center or Health Statistics. Health, United States, 1999. Hyattsville, MD, 1999; U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. Health Statutes and Limitations: A Comparison of Hispanics, Blacks, Whites, 1996. Rockville, MD, 1999; Collins KS et al. U.S. Minority Health: A Chartbook. New York: The Commonwealth Fund, 1999.

3. The Washington Post, Kaiser Family Foundation, Harvard University Survey Project. The Four Americas: A Report on Government and Social Policy through the Eyes oif America’s Multi-racial and Multi-ethnic Society. Menlo Park, CA: Kaiser Family Foundation, 1999.

4. The Henry J. Kaiser Foundation. Race, Ethnicity and Medical Care: A Survey of Public Perceptions and Experiences. Menlo Park, CA, 1999.

5. Blendon RJ et al. How White and African Americans view their health and social problems: Different experiences, different expectations. Journal of the American Medical Association 1995; 273(4): 341-346.

Acknowledgments

This book is the culmination of many years of research, experience in academic medicine, and clinical practice. Without the aid and assistance of many individuals, institutions, and sponsors it could not have been completed. As foundation stones of intellect and inspiration we are all indebted to men like Drs. James McCune Smith, Martin Robison Delany, John Sweat Rock, George Whipple Hubbard, Robert F. Boyd, Charles Victor Roman, W. E. B. Du Bois, John A. Kenney, and General Oliver O. Howard, who laid the building blocks in the quest for justice and equity in health care for all people in the United States beginning in the nineteenth century. Often obscured by their high-profile abolitionist or academic careers, or buried behind the “veil” of racism, their accomplishments as health professionals deserve resurrection. Building upon these historical legacies and inspired contemporaneous leadership provided by scholars committed to progress in African American health, such as Drs. Hildrus Poindexter, W. Montague Cobb, Herbert Morais, Julian Lewis, William Darity, M. Alfred Haynes, and Paul Comely, this book strives to continue their efforts. All of these often unacknowledged pioneers provided the energy and inspiration for this book.

Institutions that supported both authors as they worked on this project deserve recognition. Meharry Medical College in Nashville, the Harvard School of Public Health (HSPH) in Boston, the State University of New York Medical Center at Brooklyn, Boston’s Beth Israel Deaconess Medical Center, and Boston’s Roxbury Comprehensive Community Health Center and Dimock Community Health Center hold permanent places in our hearts and souls. Other supportive institutions and organizations worthy of mention are the National Medical Association (NMA); the Congressional Black Caucus; the Summit Health Coalition in Washington; the Ennix-Jones Center of the First Baptist Church Capitol Hill in Nashville, Tennessee, while under the leadership of Reverend Ces’ Cook; and the Black Churches and Black Colleges Network headquartered in Detroit, Michigan. Their assistance was critical in the realization of this project.

We will forever be indebted to AT&T, which funded our postdoctoral fellowships at Harvard. The Tennessee Managed Care Network and the Medical Care Management Company provided pivotal financial support, without which this project could not have been completed. The Harvard Pilgrim Health Care Foundation funded this project’s bridge into multicultural medicine. The Robert Wood Johnson Foundation sponsored various projects on African American and disadvantaged minority health care that were indirectly related to the book. Without these corporate and institutional sponsors this work would not have been possible.

Special access to research resources was provided by Ms. Mattie McHollin and Ms. Cheryl Hamburg of the Kresge Learning Resource Center of Meharry Medical College; Ms. Beth Howse, Special Collections Librarian of the Fisk University Library; and Mr. and Mrs. Wolff and Ms. Madeline Mullin of the Rare Book Room of the Countway Library of Medicine of Harvard. The Widener, Lamont, and Tozzer libraries of Harvard provided rare and focused resources for the research. Special thanks are extended to Ms. Salena Abrams of the National Cancer Institutes (NCI) library and her colleagues at the National Library of Medicine who provided so much medical historical material. We will be forever indebted to these individuals and the professional staffs of these various institutions.

We are forever indebted to our editors. Mr. Ricardo Guthrie, our colleague during our Harvard training years, reemerged to become our “Maxwell Perkins” editorially on the entire book project. We cannot begin to articulate our sincere appreciation for Mr. Guthrie’s overall role as consultant editor, researcher, and scholar in African American Studies during the latter phases of the project. A special note of appreciation is made for his exceptional ability to lend clarity and ease of reading to areas that were extremely complex, highly technical, or medically and scientifically oriented. We will be eternally grateful for his contribution. Mr. Kevin Ohe and Ms. Sylvia Miller at Routledge are advocates for the project who then orchestrated the book’s progress through the complex publishing process.

Academicians who lent their expertise in preparing this manuscript include Dr. Lucius Outlaw, philosopher and international authority on race from Haver-ford College; Dr. Robert Robinson, Associate Director, Office of Smoking and Health of the Centers for Disease Control and Prevention in Atlanta; Dr. Michael Blakey, chief anthropologist at Howard University and director of the New York African Burial Ground Project; and Dr. Cassandra Simmons, associate dean for students while at HSPH. Other scholars who heard, analyzed, and helped shape some of the content of the project were Dr. Deborah Prothrow-Stith of HSPH; Dr. Claudia Baquet of the University of Maryland School of Medicine; Dr. Ces’ Cook, CEO of Faith-Based Centers of Excellence in Nashville; Dr. Leslie Falk, retired professor of family practice and nationally noted medical historian and health policy authority of Meharry; Dr. Charles Finch, of the Morehouse School of Medicine; Dr. Richard Allen Williams, author and founder of the Minority Health Institute in Los Angeles; Dr. B. Waine Kong, CEO of the Association of Black Cardiologists, Inc., in Atlanta; Mrs. Cheryl Hamburg, library director at Meharry; Dr. Robert Guthrie, noted academic psychologist and researcher; and Dr. Todd Savitt, medical historian of East Carolina University Medical School. Mrs. Joan Clayton-Davis, Program Manager of the Academy of Educational Development of Nashville, provided advice and encouragement, served as a sounding board, and read parts of our manuscript incisively and objectively. Her unwavering support and her comments and input were greatly appreciated. We thank Dr. Stephen Jay Gould, anthropologist at Harvard University, for sharing his library and expressing his interest and support for the project.

Many individuals have been sentinels of support and encouragement for this project. Some include Dr. Robert Jay Blendon and Dr. Deborah Prothrow-Stith of HSPH; Dr. Charles Johnson of Duke University, who was a bulwark of inspiration, encouragement, and support, serving in many ways as “father” of this project; Anthony Cebrun, J.D., M.P.H., whose indefatigable interest and support served as a spiritual beacon guiding this complex project to realization; the late Dr. Robert Hardy (“Bob”), our intellectual conscience, critic, policy analyst, and confidant—besides being a dear friend and spiritual support for both of us; Drs. Camara Jones and Bryan Gibbs of the Division of Public Health Practice at the HSPH; Drs. Eric Buffong, Richard Butcher, Ezra Davidson, Avis Pointer, Tracy Walton, Mike Lenoir, Yevonnecris Veal, Gary Dennis, Patricia Hart, Gilbert Parks, Anita Jackson, and Calvin Sampson, all of the NMA; Mrs. Rosemary Davis, Ms. Ruth Perot, Dr. Noma Roberson, and Dr. Ces’ Cook, who provided spiritual, intellectual, and material support throughout the project; Ms. Sheree Bishop, videographer Chris Rogers, nurse Sandy Hamilton, Mrs. Linda Williams, and Mrs. Mary Lou Cornett, who provided vital academic, technical, and graphics support; Congressman John Conyers, Congresswoman Eva Clayton, Congressman Louis Stokes, Congresswoman Donna M. Christian-Christiansen, Congressman Earle Hilliard, and Congressman Bobbie Scott of the CBC; Drs. David Satcher, throughout his tenures as president of Meharry, director of the Centers for Disease Control and Prevention in Atlanta, and as sitting Surgeon General; Louis Bernard, chairman of the Department of Surgery at Meharry Medical College; Dr. Audreye Johnson, of the Department of Sociology of the University of North Carolina; Mrs. Joyce Clayton of the University of North Carolina; and Dr. Henry Foster, who will always be our mentor and chief. Health journalist and social scientist Dr. Kirk Johnson lent immeasurable aid in the editorial preparation and structuring of both volumes. Drs. John Boyce and Louis Camilian of SUNY-Downstate Medical Center lent unremitting support during the late stages of the project while my father was ill. Their loyalty and sensitivity will never be forgotten. Other lifelong supporters whose friendship and support blossomed around us in Brooklyn were Drs. Cathy Roans and Reba Williams and the staff of Kings County Hospital Center. Dr. Ruth Browne, Director of the Arthur Ashe Institute of Urban Health at SUNY-Down-state Medical Center, and her family provided pivotal support during our time in Brooklyn. We also thank Dr. Lemuel Evans of the National Career Institute, who always encouraged our work.

Providers of indirect, but critical, support were Mrs. Ruth Baker and members of our family in Fort Worth, without whom the lead author could not have survived the stresses in his life, and Mrs. Lois Henderson, a linchpin of our extended family, who served as a life-sustaining force for both authors. We will be forever indebted to our brothers (Larry, Burley, Walter, Douglas, and Donald), sisters (Joan, Maxine, Doris, Alice, and Judy), nieces, nephews, cousins, other family members, and friends who gave their encouragement and support—without which this project would have been impossible.

The authors also acknowledge the special support provided by Mr. Ziad Obeid and the staff of the Division of Public Health Practice of HSPH. Ms. Scar-lett Bellamy and Ms. Knashawn Hodge, of the Department of Biostatistics at HSPH, provided irreplaceable biostatistical support and expertise. We thank the staff and personnel of the Department of Health Policy and Management at HSPH, especially Ms. Elizabeth Marshall, Marilyn, and Ms. Dawn Linehan Elliot. The Computer Lab at HSPH, especially Sydney and Phillipe, lent invaluable assistance. The resources of Harvard University’s massive library and research infrastructure were freely utilized. Meharry Medical College Library, the National Library of Medicine, Fisk University Library, and several private libraries were also used. Without the support of these institutions and their staffs, preparing this book would have been much more difficult. The audiovisual departments at Meharry Medical College, the Beth Israel Deaconess Medical Center of Boston, and Chromatics of Nashville lent invaluable aid and assistance in preparing visual material for the book.

Others who provided valuable support include Dr. Ben Sachs, Dr. Susan P. Pauker, Dr. Lucille Norville Perez, Dr. Augustus White, III, Dr. Louis Sullivan, Dr. Herb Dreyer, Dr. Jack H. Geiger, Dr. Gabrielle Bercy-Roberson, Kerby Roberson, Esq., Ms. Sheila Thorne, George Heirston, Esq., Dr. Ken Edelin, Dr. David Harris, Ms. Seleste Harris, Mrs. Sylvia Watts-McKinney and the staff of the African Meeting House, Mr. Jim Scott, Mrs. Jackie Jenkins Scott, Rev. Ed Blackman, Mrs. Sandra Blackman, Rev. Ozzie Edwards, Rev. Carolyn Corey, Mrs. Darlene Pope, Mrs. Ervina Jarrett, Mrs. Marilyn Thomas, Mrs. Carol Taylor, Mr. Monroe “Bud” Mosley, Ms. Dianne Kenney, Dr. John A. Kenney, Jr., Mrs. Sherry Pajari-Joseph, Mr. Randal Rucker, Mrs. Beatrice Riley, Mrs. Vina Fils-Amie, Mrs. Phyllis Cater, Mr. Elmer Freeman, Dr. Gillian Barkley, Ms. Anita Hamilton, Mr. Phillip Aquan, Mr. Briars Davis...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures and Tables
• Foreword
• Foreword to Volume One
• Acknowledgments
• Preface
• Introduction
• PART I Race, Medicine, and Health in Early Twentieth-Century America
• PART II Race, Medicine, and Health before, during, and after the Black Civil Rights Era
• PART III The Coming of the Corporation
• PART IV Race, Medicine, Health Reform, and the Future
• Appendixes
• Glossary
• Notes
• Select Bibliography
• A Note on Sources
• Credits
• Index