Health is politics by other means.1
Milestones in health and medicine are conveyed as bearing on the broadest political and social ideals. The recent tenth anniversary of the decoding of the human genome, for example, brought with it cautious hope for the progression of genetic science from the lab bench to the bedside. This scientific landmark was notably accompanied by then president Bill Clinton’s proclamation that this feat had established “our common humanity.”2
Health is also deemed to embody conceptions of the good society. In 2010 the administration of President Barack Obama ushered in historic healthcare reform with the Patient Protection and Affordable Care Act. At the time of its passage, this legislation marked the most sweeping changes in U.S. health policy since the establishment of Medicaid and Medicare in 1965. The Affordable Care Act, which promised to extend medical benefits and coverage to tens of millions of previously uninsured and underinsured Americans, was passed despite heated partisan debates redolent of the political battles over health policy of the late 1960s. The controversy that preceded (and then followed) the implementation of the act concerned far more than bodily well-being. Underlying the impassioned back-and-forths that pitted accusations of “socialized medicine,” “government takeovers,” and “death panels” against assertions of “a right to health” and the ethics of “universal health care” were stark ideological distinctions—Republican versus Democrat, laissezfaire versus interventionist, libertarian versus progressive. In other words, healthcare reform was the dialect through which fundamental political disagreements about the proper function of the state and the appropriate parameters of business influence were articulated.
Also contested under the banner of health were the very terms of social inclusion in the United States. While the Obama administration and many on the left sought to expand the health polity to include those who lacked medical care, some on the right framed healthcare reform as centrally concerning the constriction of citizenship. The conservative pundit Glenn Beck, for example, suggested with a question to his radio audience that one’s position on so-called Obamacare boiled down to an issue of national loyalty: “Are you an American or a European?”3 Rush Limbaugh, for his part, craftily constructed the reforms that would draw the United States closer than ever before to universal healthcare coverage as benefiting the few over the many. It was African Americans who would be the beneficiaries of changes to national health policy, Limbaugh complained to his listeners, adding that proposed reforms amounted to “reparations” and a stealth “civil rights act.”4 Healthcare reform discourse was couched in competing claims about what constituencies mattered, which lives were valued, and what bodies were deserving of biomedical care.
As revelations of the last few years demonstrated, health and medicine can be vectors of power, political and otherwise, in further ways. Questionable scientific practices conducted with vulnerable communities that have recently come to light make evident this register of health politics. In 2010 the historian Susan Reverby uncovered the deliberate infection of Guatemalan men and women with syphilis in the late 1940s by a U.S. researcher who was also involved with a notorious study of the disease in Tuskegee, Alabama, that began in the 1930s.5 As with the Tuskegee study, this Latin American syphilis experiment was undergirded by “racialized assumptions” that attributed the frequency of the disease among minority populations to their supposed moral inferiority and biological peculiarity.6 In a somewhat similar vein, the journalist Rebecca Skloot recently and vividly depicted how a Johns Hopkins researcher surreptitiously appropriated the fatally prolific cervical cells of Henrietta Lacks, a black working-class woman who died of cancer in 1951. In the second half of the twentieth century, Henrietta’s thriving cells became vital to modern science, even as the Lacks family was devastated, over the same decades, by the many consequences of her loss.
Reverby’s and Skloot’s revelations compounded an already bleak record of vexed, uneven encounters between agents and racialized subjects of biomedicine that the science writer Harriet Washington has characterized as “medical apartheid.”7 On top of the long history of dubious and often invidious research with black subjects delineated by Washington, racially discriminatory practices in medicine have included Jim Crow healthcare facilities; a formerly segregated medical profession; stubborn health disparities evidenced by many indices; and “unequal treatment” for blacks under medical treatment protocols for such conditions as cancer and heart disease.8
This cascade of medical discrimination has had far-reaching implications. Racial health disparities in the United States, for example, have been shown to persist partly because of African American communities’ past and continued distrust of the medical system. Owing to this trepidation, developed over generations in response to abuse, neglect, and racialization, some blacks are reticent about or even resistant to seeking necessary healthcare or participating in research studies.9 By way of a corrective to this shared apprehension—that is quite literally sickening in result—Washington has bravely proposed that shining a light on medical apartheid may effect a kind of social catharsis that will “remove barriers between African Americans and the bounty of the American health-care system.”10
Yet in the years after the publication of Washington’s acclaimed book, occurrences such as the strong resistance in some quarters to the H1N1 virus vaccine, reportedly grounded in fears of maltreatment, suggest that uncovering past abuse may not in and of itself inspire public confidence in biomedicine and the healthcare system.11 More pointedly, at a time when the subjection of marginalized communities to biomedical authority is attracting renewed attention, the recuperation of moments during which members of these groups endeavored to shift the balance of power in medicine may be an effectual counterweight to enduring medical mistrust. Body and Soul uses one such case to illustrate circumstances in which African Americans confronted medical discrimination in the healthcare system, in biomedical theories, and in research design. In doing so, these communities did not assert a blanket rejection of medicine. Rather, they laid claim to a critical conception of healthfulness: a right to health equality and freedom from medical discrimination.
This book began more than a decade ago as a reflection on the intersections of science and race via the works of Lee D. Baker, Troy Duster, Stephen Jay Gould, Evelynn Hammonds, Sandra Harding, Dorothy Roberts, Audrey Smedley, William Stanton, Keith Wailoo, and others.12 In response to this eclectic body of writing that, very generally speaking, considered the stakes of racial formation and racial subjugation in and through science, I became interested in exploring whether and how African Americans responded to these processes. Given that scientific practices have played (and continue to play) a key role in constructing ideas of race, were challenges to biomedical racialization an element of the African American protest tradition? If so, at what moments and through which tactics did black communities strive to tilt the balance of authority from researchers and physicians to subjects and patients?
It was with these questions in mind that I began to explore African American health advocacy in the twentieth century and, eventually, to carry out research into the Black Panther Party’s health politics of the late 1960s and early 1970s. Although I had passing knowledge of the Party’s health-related activities, delving deeper, I also discovered that the organization’s endeavors were both more extensive and more multifaceted than I had imagined. In investigating Party health initiatives, I perceived that its activism both reflected and amplified the distinctiveness of a tradition of black health advocacy in which pragmatic matters of disease and healing (e.g., the founding of health institutions) were coextensive with broader political matters (e.g., challenges to racism).
In addition, I observed that the Party’s health politics ranged from practical issues to ideational concerns. The organization’s efforts included providing basic medical care to the poor, working with lay community members and trusted professional health workers in alternative facilities established by the activists. The Party furthermore engaged in public debates in which they disputed the racial biology of violence and research studies based on this assumption. And it also boldly advanced suggestions for how genetic studies of human groups could be refined to avoid justifying racism. The Party’s health politics was therefore wide in scope and responded to a broad set of needs. The activists and the communities with which they worked confronted the paradox of profound healthcare neglect and disparate biomedical inclusion: poor blacks were not only medically underserved but also overexposed to the worst jeopardies of medical practice and bioscientific research. The resulting lack of comfort and familiarity with preventive medicine and attendant fear of biomedical abuse remain salient factors contributing to health inequality.
My exploration into the Party’s health activism accordingly yielded insight into how a segment of African Americans endeavored to gain access to reliable, affordable healthcare services while placing a check on the authority and racial claims of biomedicine. This course of research, however, presented me with some unexpected challenges. Although the Party’s activities were exhaustively documented in the mainstream and alternative media of the time, and continued to be accounted for in both memoirs and scholarship of subsequent years, little of this coverage treated health-related activities in any detail. This oversight was likely because of preoccupation with other, more sensational matters. For, as the communications studies scholar Jane Rhodes suggests, the Party’s activities were “framed,” for the most, by mainstream press representations that “focuse[d] attention on selected aspects” of the organization—most particularly its surveillance of local police and its armed militancy.13 For these reasons, in the writing of this book, I encountered ample textual and visual resources about the more spectacular facets of the Party, but substantially less information about its health politics. Uncovering details about this element of the Party’s activism consequently required bridging several fields of inquiry, including sociology, history, and African American studies, as well as using an ecumenical methodology that combined archival, hermeneutic, theoretical (and to some degree, ethnographic) approaches.
Specifically, Body and Soul draws on primary sources culled from government documents and official correspondence, state and library archives, ephemera and personal papers. A survey of the voluminous press coverage of the Party on broadcast television, documentaries, magazines, and in mainstream and alternative newspapers was consulted alongside close reading of the group’s weekly newspaper, the Black Panther. Launched in 1967, the paper—even in its most propagandistic moments—provided the most complete record of the Party’s health-related activities and of the broader political aspirations to which these were linked.14 Some chapters of the Party occasionally published their own newsletters, and I made use of these as well.
Secondary literatures in post–World War II African American history, the long civil rights movement, the social studies of science and medicine, and social movement theory helped me conceptualize the Party’s health politics. In addition, in crafting this account, I relied on medical journals and scientific papers from the 1960s and 1970s. Editorials and essays in these publications featured scientific and policy debates in biomedicine and also supplied a glimpse into medical professionals’ perspectives on the emergence of health radicalism, including that of the Party.
The book draws on my encounters with many former Black Panthers and their collaborators. Interviews with Norma Armour, Elaine Brown, Arthur Harrison, Billy X Jennings, Cleo Silvers, Bernard Thompson, and other Party members contributed crucial details about the practical operation and political framing of the health-related aspects of the group’s activism. I also relied on the published oral histories of Party members and consulted as well several Panther memoirs penned over the last four decades. In October 2006 I attended the Party’s fortieth-anniversary gathering in Oakland, California, during which members narrated the organizational histories of their respective Party chapters. During the telling of these collective oral histories, the activists expounded on the breadth of the Party’s health-based programming, among many other matters.
Health and medicine are unique among the bases of collective action for the degree to which political interventions in these domains may rely on deep engagement with expertise and, moreover, often necessitates that like-minded members of the professions aid the social movement (even in the case of those radical health movements in which a critique of expertise is a centerpiece of the activism). As a result, this book additionally reflects my interviews with members of the professions who worked in solidarity, and often shoulder to shoulder, with the Black Panthers. The remembrances of several Party collaborators—including the attorney Fred Hiestand, Dr. Marie Branch, Dr. William Bronston, Dr. William Davis, Dr. Terry Kupers, and Dr. Tolbert Small—elucidated the lay-expert network that undergirded and facilitated the Party’s health initiatives.
Visiting former locations of Party chapters and clinics in Oakland, New York City, and Seattle was also instructive. I made trips to sites that remain as material manifestations of the Party’s activism, such as the Harriet Tubman Medical Clinic in West Oakland, California, that was established by Small in the late 1970s and still today serves poor clients in the Bay Area. I also visited Seattle’s sliding-scale Carolyn Downs Family Medical Center named for and inspired by the work of a late Black Panther, who in 1968 established the local Party chapter’s clinic at a nearby location. A novel and more complex picture of the Black Panthers resulted from the amassing of these eclectic resources.
The progress of the Party’s health activism—from the group’s founding in 1966 to its reconsolidation in Oakland in the 1970s, after rapid organizational growth—occurred in the years immediately after the legal dismantling of Jim Crow, by way of the Civil Rights Act (1964) and the Voting Rights Act (1965). There were concomitant transformations to the social welfare system, especially the expansion of the United States as a healthcare state, exemplified by the passage of the Social Security Act (1965) that installed the Medicare and Medicaid programs. In this same period, there was an increase in state policies and programs related to healthcare that issued from President Lyndon B. Johnson’s War on Poverty along with determined pushback from medical lobbies and the insurance industry. The antipoverty programs were swiftly followed by cries of a fiscal “health crisis” from the administration of President Richard M. Nixon that engaged in austerity politics and enacted severe budget cuts. This time also saw a “health crisis” of credibility in the early 1970s when revelations of the Tuskegee syphilis study and the forced sterilization of numerous black women, including most disgracefully the teen sisters Minnie and Mary Alice Relf, who were deceived into submitting to surgical sterilization, came to light.15
From the purview of the Party’s health politics, it becomes possible to, in the words of the sociologist Charles Tilly, see “how people lived the big changes” or, put another way, to perceive how ordinary people experienced these and other pivotal societal transitions.16 It was no coincidence then that the Party’s health politics (and activism more generally) emanated from a constellation of consequential social-structural transformations, including the advent of a postindustrial economy, the slow diminution of the American welfare state, and the social and legal developments of the civil rights era that immediately preceded the Party’s birth. At this critical juncture in the late 1960s and early 1970s, health offered new moral terrain for a struggle that was no longer typified by the Manichaean inscription of “whites only” signs and Jim Crow transportation, employment, accommodations, and schooling, but instead by the vacillation of social abandon and social control. Through their health politics, the Black Panthers laid claim to recent civil rights landmarks even as they stridently exposed the limits of those milestones under late capitalism.
An early instantiation of what might be described as postsegregation politics, Party health activism also prefigured issues of relevance in the so-called postracial era, most particularly, the significance of race after the genomic turn and what integration into this “brave new world” proffers for African Americans given historic vulnerability to biomedical authority. Shaped by past tragedies, contemporaneous inequality, and future optimism, by the recognition that biomedicine is both rocky and curative terrain, the Black Panthers’ politics of health and race exhibited twinned aspirations: defense against biomedical neglect with hope of attaining full civil, social, and human rights.