In 1962 the National Association for the Advancement of Colored People, the leading and largest civil rights organization of the twentieth century, filed suit on behalf of a group of African American medical professionals and their patients in opposition to “separate but equal” medical facilities, in hopes of toppling the edifice of racism, improving healthcare for blacks, and according a modicum of dignity to those most likely to treat them. A centerpiece of the “medical civil rights movement,”1 this initiative was spearheaded by the NAACP Legal Defense and Education Fund and two members of the faculty of the Howard University Medical School, the physicians Paul Cornely and W. Montague Cobb. Cobb was, at this time, head of the NAACP’s National Health Committee and a member of its board of directors. Editor as well of the Journal of the National Medical Association (JNMA), the periodical of the professional organization for African American physicians, Cobb used that publication as his bully pulpit, driving home his argument that black doctors should not acquiesce to medical Jim Crow.2 Encouraged by Cobb’s intrepid editorials, and the recent Brown v. Board of Education of Topeka, Kansas Supreme Court decision that outlawed separate-but-equal public schools, the plaintiffs, a group of black doctors, dentists, and patients in Greensboro, North Carolina, launched a successful challenge to segregation in state-funded medical institutions.3 The resulting Simkins v. Moses H. Cone Memorial Hospital decision handed down in 1963 by the U.S. Court of Appeals for the Fourth Circuit (and later upheld by the U.S. Supreme Court), outlawed the practice of segregating hospital staff and wards by race in all facilities receiving public monies.4 Although the Simkins medical desegregation case is less well-known than Brown v. Board, it is a reminder that health activism was intrinsic to the long civil rights movement, despite the fact that the topic is often marginal to histories of the black freedom struggle.5
In this chapter, I mine some of this little-known yet extensive history of African American health-focused activism as necessary context for understanding the Black Panthers’ health politics.6 While the battles in which the Party was engaged were specific to its time and ideological commitments, they were also in keeping with how black Americans had, for generations, responded to the life-or-death stakes of racialized health inequality. This chapter surveys signal moments of the long civil rights movement and excavates from within this arc of protest what might be termed the “long medical civil rights movement,” a parallel tradition that took health as its focus. Mobilized in response to the distinctly hazardous risks posed by segregated medical facilities, professions, societies, and schools; deficient or nonexistent healthcare services; medical maltreatment; and scientific racism, activism challenges to medical discrimination have been an important focal point for African American protest efforts and organizations. The Panthers were heirs to health activism that directly reflected tactics drawn from this tradition. Its health politics, which combined attention to practical needs with a reframing of the definition and stakes of black well-being, were deep-rooted in African Americans’ prior responses to health inequality, including principally the following: institution building, integrationism (or inclusion), and the “politics of knowledge.”7
Institution building refers to the establishment of parallel facilities, alternative health initiatives, and autonomous organizations to compensate for a paucity of accessible healthcare options. As the historian of medicine David McBride describes, the black experience in the United States has been punctuated by epidemics, including tuberculosis and cholera owing not only to disease agents but also to poverty, healthcare inequality, and racial segregation.8 In each case, the human, scientific, and capital resources allocated by public health agencies to curb these epidemics were often insufficient. In the early twentieth century, philanthropic organizations such as the Julius Rosenwald Fund helped fill this void—if only to protect white communities from the supposed scourge of black contagion. These efforts notwithstanding, adequate healthcare accommodations and services for blacks remained severely lacking throughout the twentieth century.9 African Americans founded hospitals in underserved black communities, inaugurated public health initiatives, and established schools to train black medical professionals.10 Given the long shadow of and neglect cast for decades over African American well-being, reformers and activists unsurprisingly worked to establish alternative avenues for delivering healthcare services and health education to black communities.
The desegregation of the healthcare system and the medical profession was a central aim of African American health activism. Integrationism was the organizing principle of black health advocates for much of the twentieth century and a second important tactic. This position was ardently endorsed in the writings and speeches of W. E. B. Du Bois and other leading black thinkers who insisted on blacks’ right to full inclusion and participation in U.S. society—including its health-care institutions. Health integrationists aimed to desegregate medical institutions, including professional associations, hospitals and clinics, and schools and training programs. They pushed for comparable and shared facilities and services for black and white medical practitioners and patients. They believed that African Americans’ full inclusion in the healthcare state offered the best hope for reducing rates of mortality and morbidity in black communities. These health activists used the legal system to force open the doors of hospitals to black patients and challenged the medical establishment gatekeepers who placed a “color line” on the possibility of professional development for black doctors, nurses, and other medical workers. More idealistically, this tactic pushed U.S. society to live up to its egalitarian claims in the domain of health.
A third tack taken by black health activists was “the politics of knowledge.”11 Understanding that the creation of knowledge about black bodies in medicine was often an ideologically charged process, health advocates also deployed the politics of knowledge, the pursuit of intellectual projects, and conceptual interventions that in varying degrees challenged medical authority and disrupted biomedical racialization. Activists reinterpreted scientific findings, conducted independent research programs, and employed social scientific analysis to demonstrate that racism, not rationality, was at the root of scientific claims about the alleged inherent inferiority of African Americans.12 Those using a politics of knowledge approach often worked to forge connections between biological, social, and political spheres of life in response to the scientific determinism of some biomedical theories.13 This tactic opened the way for black well-being to be assessed in the context of issues of social justice and racial equality—a course that was reflected in the Party’s health politics and its social health perspective.14
The use and significance of the tactics of institution building, integrationism, and the politics of knowledge in the African American health activism tradition are elaborated below. To some degree, the Black Panthers made use of all of them. They created alternative spaces for the healing and medical training of blacks. They demanded inclusion and racial equality in medicine. And they posed epistemological challenges to biomedical claims about race.
African American activists’ responses to the dynamics of racism in the health professions and in medical institutions took many forms partly because the health needs of black communities were often so great. McBride notes that the abominable health status of blacks underwent “scant change” in the many decades from “the late slavery era to the start of the Great Depression.”15 “Excess black mortality and morbidity” remained constant even in “periods when medical care technology and political integration, or both, [were] advancing,” McBride continues.16 Thus, even as social conditions gradually improved for African Americans, their health status remained excessively compromised compared with whites.
In the face of epidemics and other health crises that disproportionately affected them, black communities had little choice but to provide their own solutions to what ailed them. Grassroots efforts to develop healthcare facilities, public health education, and educational institutions—frequently collaborations between communities and medical professionals—were one solution. Institution building also entailed disseminating health education to black communities, many of which, owing to both tradition and racial exclusion, had little experience with, or faith in, mainstream public health systems. Because of the wide impact that forms of medical segregation had on African American populations, their response was similarly extensive; health activists not only aimed to increase black communities’ access to healthcare services but, in some instances, also provided otherwise scarce training and employment opportunities for black health professionals.
Black communities played crucial roles in institution building: although physicians and race leaders often served as figureheads and visionaries, efforts to provide healthcare services were often funded and administered by dedicated laypeople working to improve the welfare of their communities. In addition, activists established public health campaigns to provide instruction on such issues as sanitation and hygiene and to disseminate information central to eradicating diseases that disproportionately plagued black communities.
Some alternative institutions were established through the collaborative efforts of black doctors and nurses. Yet for the most part, this institution building could not depend on black professionals solely because, for much of the twentieth century, there were too few of them. Accordingly, laypeople—including club women, community organizers, and churchgoers—played a crucial role in devising ways to stretch their communities’ professional resources and in confronting health inequality. Through donations of time and labor, black health activists established healthcare institutions and educational campaigns. In particular, these efforts were often organized by women working through both sacred and secular institutions such as social clubs.17 Just as in the black protest tradition in the American South in which the “men led but women organized,”18 these institution-building activities often had a gendered division of labor.19 This was especially true of Progressive Era black health activism, during which the caring burden landed on black middle-class women committed to improving community health, and who filtered this concern through the prevailing imperatives to nurture and uplift the race, alleviate poverty, and promote high moral standards.20
Progressive Era Institution Building: Provident Hospital and Booker T. Washington
The labors of black women health activists, for example, were foundational to the creation of Provident Hospital and Nurses’ Training School in Chicago at the initiative of Daniel Hale Williams. Williams, a cofounder of the National Medical Association (NMA)—the African American physician’s association formed partly in reaction to the segregated practices of the American Medical Association—was committed to improving the health of black communities and the working conditions of black medical professionals. Fueled partly by his aspiration to develop a nursing program for black women, Williams opened Provident in 1881 in a modest, converted two-story home that accommodated a dozen beds.21
The establishment of Provident owed in some measure to financial support from both black donors and white philanthropists.22 Although some African Americans who contributed were wealthy, most donated small monetary contributions and labor. Provident’s women’s auxiliary board volunteers organized social events, the proceeds of which went to the hospital’s efforts. The board expanded the women’s existing fund-raising programs and launched a public health campaign to reduce black infant mortality and improve the health of black children. The women’s auxiliary provided monies to purchase much-needed supplies and equipment. Members of the surrounding community donated provisions and furnishings from their homes, including food, furniture, and linens.23 The collective effort required to establish Provident as an institutional alternative to medical Jim Crow exemplified how black communities—professionals and laypersons, men and women, rich and poor—together responded to the dearth of medical care providers and adequate health facilities in their communities and otherwise negotiated the discriminatory practices of the mainstream health establishment.
In March 1915, two decades after the founding of Provident Hospital, Tuskegee Institute’s founder and principal Booker T. Washington initiated National Negro Health Week.24 Although by this time Tuskegee had already constructed its own icon of black health self-help by establishing Tuskegee Hospital and Nurses’ Training School in 1892, National Negro Health Week was a more ambitious endeavor. With this initiative, Washington and those who took up the health activist mantle after his death in the fall of 1915 inspired health consciousness in black Americans, built a national infrastructure of health education, and coordinated local initiatives into a large-scale, nationwide campaign.
Washington, who founded Tuskegee Institute in 1881 and by the turn of the century had established it as the center of black American life, had long been concerned with (and had long connected) issues of health and hygiene. Washington developed a preoccupation with these issues as a young man working for the wife of the local coal mine owner. He described the training in cleanliness and orderliness he received as being as “valuable” to him as his later scholarly education.25 Perhaps as a result, he secured a place as a student at the Hampton Institute—with no tuition because he was unable to pay—by impressing a college administrator with his ability to wash and tidy a room.26 Washington’s distinct passion for hygiene was later articulated in the ground rules and institutional culture at Tuskegee Institute and in the eventual founding of Tuskegee Hospital. Prospective Tuskegee students were well versed in the “gospel of the toothbrush,” as the dissertation in Washington’s autobiography about the importance of oral hygiene was known.27 Some of his attention to hygiene no doubt stemmed from the fact that such matters were a characteristic concern of the Progressive Era, as reflected in the parallel development and expansion of the public health sector at this time. However, Washington also linked these issues to the project of black uplift more generally.28
The seed for National Negro Health Week was planted after Washington observed the thriving programs of the Negro Organization Society of Virginia, whose motto “Better Schools, Better Health, Better Homes, Better Farms” reflected a commitment to health-related uplift.29 The organization had launched a successful sanitation and cleanup campaign among black Virginians as a bulwark against disease. In a 1914 address before the organization, Washington praised its members for “emphasizing the matter of health, the matter of cleanliness, the matter of better sanitary conditions throughout Virginia.”30 The example of the Negro Organization Society and the limited success of the health campaign persuaded Washington to take the campaign to the national level. Washington embarked on the planning of National Negro Health Week through which he hoped both to coordinate and to extend existing health activities in black communities.31
This visit to Virginia was also the occasion for the airing of Washington’s convictions about the larger importance of health in southern racial politics. In his speech, he argued that segregation was the cause of much black disease and illness: “Wherever the Negro is segregated, it usually means that he will have poor streets, poor lighting, poor sidewalks, poor sewage, and poor sanitary conditions generally.” He continued, “Segregation is not only unnecessary, but, in most cases, it is unjust.”32 Washington is most often remembered as an accommodationist for his less-than-radical approach to segregation, particularly for his famous Atlanta Compromise speech of 1895 during which he proclaimed that “in all things purely social we can be as separate as the fingers, yet one as the hand in all things essential to mutual progress.”33 However, Washington the health activist was, if not an integrationist, certainly an antisegregationist.
Perhaps more predictably, given his emphasis on vocational and industrial training, Washington contended that illness impeded the ability of blacks to be effective workers: “A weak body, a sickly body, is costly to the whole community and to the whole state [Virginia], from an economic point of view.”34 Washington also stressed (and cautioned whites about) the interdependence of black and white lives in the South. He maintained that if the health needs of blacks remained unmet, segregation could not save white communities from exposure; he cautioned that “disease draws no color line.”35
With five hundred dollars from the white philanthropist Anson Phelps Stokes and the support of the Negro Business League, the National Urban League, and others, Washington held the inaugural National Negro Health Week in March 1915.36 The campaign stressed the “organization of clean-up committees, special health sermons by colored ministers, health lectures by physicians and other competent persons, the thorough cleaning of premises, including dwellings, yards, outbuildings, and making sanitary springs and wells.”37 At local sites, black community leaders in education, health, and church affairs organized programs to increase public awareness of health problems and self-improvement measures for the school and home. Health week activities—including public jeremiads proclaiming the importance of health and public health exhibits—took place in sixteen states and in many major cities. The National Negro Health Week campaign gained increasing public support throughout the 1920s and 1930s, including assistance from the U.S. Public Health Service (USPHS). Indeed, one of the original health week backers at Tuskegee Institute concluded in 1929 that the health week movement had grown so much that “‘it can be regarded as an institution.’”38 In 1932 USPHS took over administering National Negro Health Week—now called the National Negro Health Movement—by establishing the Office of Negro Health Work with the encouragement and blessings of those at Tuskegee.39 By 1950 Washington’s idea had become the basis of a nationwide state-sponsored black health program.40
Marcus Garvey and the Black Cross Nurses of the UNIA
Institution building as a mode of health activism was also evident within the ranks of the largest African American social movement in U.S. history, the Universal Negro Improvement Association (UNIA). In this case, institution building comprised healthcare facilities and services and also an alternative corps of health professionals. Founded in 1914 in Kingston, Jamaica, the UNIA’s ideological bedrock of African redemption, racial pride, and self-determination was brought to New York City by Marcus Garvey in 1916.41 In 1918 Garvey officially incorporated the U.S. division of the UNIA in New York State. Within a year, the UNIA had become hugely popular in the United States and, at its apex in the early 1920s, claimed an international membership of several million.42 The UNIA was envisioned as a black nation-state-in-waiting, as the infrastructure necessary to support the reassembly of the far-flung members of the African diaspora on the African continent. As such, the organization developed many symbols of nationhood, including a flag, national anthem, and a government.43 Garvey also established a battery of paramedicals, the Black Cross Nurses (BCN), charged with caring for “the race.” The establishment of the BCNs was a pragmatic necessity of Garvey’s nation-building plans, as the successful relocation of the African diaspora to the Old World depended on the survival and proliferation of black people in the New World.44
In August 1920 Garvey assembled a historical, month-long gathering of over twenty-five thousand national and international members of the UNIA, the First International Conference of the Negro Peoples of the World, which culminated in the formulation of the “Declaration of Rights of the Negro Peoples of the World.” This bold document began with a preamble that detailed the shared protestations of people of African descent and concluded with a bill of rights—a pronouncement of their demands. According to the preamble:
The physicians of our race are denied the right to attend their patients while in the public hospitals of the cities and states where they reside in certain parts of the United States. . . . it is an injustice to our people and a serious impediment to the health of the race to deny competent licensed Negro physicians the right to practice in the public hospitals of the communities in which they reside, for no other reason than their race and color.45
Notably, and consistent with the necessary breadth of black health activism, this statement joined the problem of racial discrimination in the medical professions to the issue of racism as an “impediment” to black health to a more general concern with social justice. Members of the UNIA agreed that the myriad causes of the lack of adequate healthcare for blacks required an urgent solution. The UNIA accordingly sought “complete control of our social institutions” through the BCNs and other endeavors.46
The BCN was one of several UNIA auxiliaries and the only one composed exclusively of female members.47 The first BCN unit was formed in Philadelphia in the spring of 1920. As BCN units expanded throughout the many divisions and chapters of the UNIA, Garvey formalized their leadership structure and mandated that they be led at the national level by a nurse with at least three years of training.48
Although the BCNs were imagined as principle healthcare providers for the UNIA organization, they also were represented as a constructive answer to black women’s limited career horizons in nursing.49 The UNIA nursing corps was modeled after the nurses of the American Red Cross, who had served at home and abroad after national disasters and during epidemics since the late nineteenth century and who tended soldiers injured in combat in World War I.50 Black women volunteered for service duty in the Red Cross during the Great War, but owing to Jim Crow few were called up.51 Given the UNIA’s avowed pessimism about equality for blacks in the medical professions and its leader’s belief that “the only hope of eventual solution to the problem of race prejudice” would come from “independent endeavor,” it was unsurprising that the organization fashioned an alternative to the Red Cross.52 Thus the formation of an alternative health cadre, the BCNs, was an example of institution building that embodied a critique of medical Jim Crow.
Members of the BCN, like their Red Cross peers, were expected to tend to the armed forces—in this case the UNIA’s own militia and the African Legion—should conflict come to pass.53 Some BCNs had formal training as nurses or midwives; however, most “worked with practical training in first aid and nutrition.”54 (The small number of practical and registered nurses in the BCN was, of course, a function of discrimination in nursing schools, such as the practices that motivated the founding of Provident Hospital.) According to the UNIA bylaws, the BCNs were primarily charged “to attend to the sick of the Division” with which they were affiliated. In addition, the nurses were expected to “carry on a system of relief” in the face of “pestilence” or natural disasters, produce materials to “educate the public to the use of safety devices and prevention of accidents,” and “instruct in sanitation for the prevention of epidemics.”55 BCNs were also responsible for “caring” duties, including tending to the homebound sick and instructing the women of the UNIA in first aid, infant care, “hygiene and domestic science,” and proper nutrition and eating habits.56 Additionally, this nurse auxiliary was at least symbolically responsible for the health of the frequently ailing Garvey and “indicated the readiness of the UNIA to come to the aid of . . . stricken [African diasporic] peoples all over the world.”57 In keeping with what the historian Tony Martin describes as Garvey’s “dual tendency to score the white race for its injustice while simultaneously utilizing the language of condemnation to spur the black race on to greater self-reliance,” UNIA health activism condemned the racist practices of the mainstream medical system and constructed alternatives to it.58
Scholars emphasize the importance of Garvey’s experiment in nation building as a source of inspiration for black power politics.59 For example, Malcolm X’s parents were members of the UNIA.60 Given that the Black Panthers were avid readers and followers of the ideas of Malcolm X, it is probable that Garvey’s examples of institution building influenced the organization. More definitively, Panther health politics of the late 1960s and early 1970s was influenced by a more historically proximate model of a health activism tactic of institution building: the clinics and medical services sponsored by the Student Nonviolent Coordinating Committee (SNCC) and its close collaborator, the Medical Committee for Human Rights (MCHR).
Model Clinics: SNCC and the MCHR
Some of the most shocking photography and television footage of the civil rights revolution of the 1950s and 1960s depicted activists being hosed down, shot, attacked by dogs, and otherwise abused. Although these images brought into the open the terrible recalcitrance of the southern white power structure, they also begged the question of who would care for those wounded on the frontlines of the battle for civil rights. Could activists who risked life and limb by merely attempting to sit at the lunch counters and in the bus depots of the deep South realistically rely on local white health professionals for emergency healthcare? Would the limited number of black doctors practicing in the South, owing to decades of discrimination in the medical profession, be sufficient to heal activists taken ill during the normal course of their organizing labors or critically injured on the frontlines of the black freedom struggle?
For the strategists behind the 1964 Freedom Summer project, a landmark event of the black protest struggle, the answer to these questions was decidedly negative. Accordingly, planners sought the participation of students and medical workers alike. Organized under the umbrella of a coalition of civil rights groups—the Council of Federated Organizations—and spearheaded by SNCC, one of its member groups, the project’s aim was to bring national pressure to bear on the white power structure that remained entrenched in the South. In the spring of 1964 SNCC field secretary Robert Moses and others settled on a strategy they hoped would turn the attention of elites to the plight of disenfranchised blacks in Mississippi: they called on white middle-class college students from the North to work alongside veteran activists on the frontline of the civil rights struggle during the coming summer. Planners counted on members of the northeastern establishment taking an interest in the well-being of their activist children and relatives and, as a consequence, develop more interest in racial politics.61
Weeks before the start of Freedom Summer, which began in June and ended in August, organizers appealed for assistance from medical professionals to provide emergency medical aid for civil rights workers in Mississippi.62 The call went out to an interracial group of physicians, dentists, nurses, medical students, and others with medical training in New York City who since 1963 had been agitating for racial integration of the American Medical Association under the banner of the Medical Committee for Civil Rights (MCCR). The organization, which altered its name slightly in 1964 to the Medical Committee for Human Rights, sent more than one hundred volunteers to Mississippi during Freedom Summer. These MCHR volunteers would establish a rudimentary health-care system for civil rights workers in Mississippi.63
Although dispatched to support the summer volunteers, medical activists were unable to ignore the impoverished conditions in which many rural Mississippians were forced to live and were distressed by the paucity of adequate healthcare services. Summer project chronicler Len Holt captured the experiences of the MCHR workers: “As these persons served, they learned. They saw and felt the interlocking chain of exploitation, poverty, discrimination, disease and human neglect.”64 Dr. David French, a leader of the MCHR, also voiced the transformation that occurred among the ranks of the medical volunteers. After journeying to Mississippi to treat civil rights workers, medical workers “found themselves suddenly in direct contact with . . . the health conditions of the Negroes living in a state of peonage in the rural areas of Mississippi. As the summer wore on . . . they desired to work together in a concerted effort to do some lasting good, not only in Mississippi but also in other areas of the deep South.”65
In response, the MCHR expanded its purview from medical care for volunteers to healthcare services for local populations. Toward this end, the MCHR established health clinics.66 For example, Dr. Alvin Poussaint, an African American psychiatrist and the southern field director of the MCHR, stayed behind in Holmes County, Mississippi, after Freedom Summer ended, to establish and manage a clinic that would provide medical care for poor local residents and serve as “a focal point for the dissemination of health education” to neighboring counties.67 Other MCHR members who remained in the South past August 1964 introduced health initiatives that included an ambitious concept for a group health plan, public health education, the empowerment of laypeople through basic training in medical techniques, agitation for more and better medical professional schools in the South, research into the health needs of local communities, and inquiries into the state provisions that were supposed to be allotted to them.68
Many Freedom Summer volunteers returned from the trenches of rural Mississippi politically radicalized.69 This was also true of the medical workers. By 1965 the MCHR had expanded from the original New York City core group to chapters in Los Angeles; Pittsburgh; New Haven; Washington, D.C.; Boston; Detroit; Chicago; and other major cities.70 Some members of the MCHR returned to the Midwest, West, and Northeast committed to making changes in the healthcare system in their home cities. Concomitantly, veteran civil rights activists encouraged their temporary cotravelers in the summer project to open their eyes to racial discrimination in their own communities and work to effect change in their own backyards.71 For example, at the first national convention of the MCHR at Howard University in April 1965, SNCC executive secretary James Foreman entreated group members to turn their attention to the needs of cities.72 A good number of health activists heeded Foreman’s suggestion. In the mid-1960s the MCHR developed a national health activist platform the signal component of which was the establishment of low-cost and no-cost health clinics.73 This extended institution building, greatly inspired by experiences accumulated during SNCC’s Freedom Summer, occupied a major portion of the MCHR agenda. Health radicals who participated in the SNCC–MCHR collaboration, such as the physicians Quentin Young and Terry Kupers, went on to work on Black Panther health projects, including its free medical clinics.
The Medical Civil Rights Movement
The integrationist, or inclusion, approach of black health activists was exemplified by the medical civil rights movement, described by the historian Herbert Morais as centrally involving a collaboration between the NAACP and the National Medical Association—the foremost professional organization for black physicians and dentists.74 The NAACP was founded in 1909 and was largely composed of black professionals, including physicians and dentists, at the local and national levels. The NMA was founded in 1895 to counter the exclusion of African Americans from medical societies and came to be regarded as the authority on matters relating to African American medical professionals and often on black healthcare in general. The NMA’s founding purpose was described by one of its leaders as a response to racial inequality: “Conceived in no spirit of racial exclusiveness, fostering no ethnic antagonisms, but born of the exigencies of the American environment, the National Medical Association has for its object the banding together for mutual co-operation and helpfulness, the men and women of African descent who are legally and honorably engaged in the practice of the cognate professions of Medicine, Surgery, Pharmacy and Dentistry.”75
The professional activists of the medical civil rights movement were, for the most part, opposed to any program in which racially distinct accommodations or treatment was sanctioned, either tacitly or explicitly, and insisted that black health be a perennial matter of national concern rather than a symbolic issue once a year. Others remained resigned to separate-but-equal healthcare until after World War II, at which time there was a groundswell of demand for integration in all aspects of the healthcare sector.76 By the late 1940s many black leaders saw full medical integration as the only viable solution for racial advancement and began to call for the demise of Washington’s National Negro Health movement.77
In large measure, the partnership between the NMA and the NAACP that resulted in the medical civil rights movement was embodied in the person and political thinking of W. Montague Cobb.78 Cobb transformed an unwieldy professional association into a political weapon. He preached the gospel of medical equality in his regular column “The Integration Battlefront,” which he instituted in the first year of his two-decade stint as editor. In this column Cobb famously asserted that separate medical programs “no matter how good do not compensate for [the] failure of integration. The ghetto no matter how beautiful is still a ghetto.”79 Also, in the late 1940s, Cobb became the chair of the National Health Committee of the NAACP and, in 1950, joined its board of directors.
The NAACP and NMA operationalized integrationism as a black health activist tactic in two principal ways: first, with pronouncements and gatherings aimed at garnering public support against segregation in medical employment and hospitalization, and second, with litigation, the modus operandi of the civil rights movement at this time. In June 1953 Cobb announced the beginning of the medical civil rights movement at an NAACP annual conference. He described the campaign, which the NMA had also approved, as being aimed at “eliminat[ing] hospital discrimination in the United States” and framed it as the next “logical step in [the NAACP’s] program to make the benefits and responsibilities of full citizenship available to all Americans.”80 He explained that the primary focus of attack was the Hospital Survey and Construction Act of 1946—also known as the Hill-Burton Act—which included provisions for federal funding for new hospital construction, the rebuilding and modernizing of the U.S. hospital system, and a clause that sanctioned separate health facilities for blacks.81 In the segregated South, the act effectively bankrolled a separate-but-far-from-equal health infrastructure. Cobb and his allies protested that federal government acquiescence to the codified discrimination of the Hill-Burton Act amounted to implicit federal approval of segregation.
While the NAACP and the NMA focused on desegregating health facilities, they also had their eyes on prizes bigger than hospital construction. The activists sought to change the very culture of medicine. Cobb argued that “the disruption of the sacred doctor–patient relationship effected when a Negro physician must leave his patient at a hospital door because he cannot be a member of the staff, must be prevented. The subtle economic exploitation of the Negro staff by white physicians and institutions through racial bars in hospitals must be brought to an end.”82 The struggle over the separate-but-equal clause in the Hill-Burton Act was therefore both juridical and symbolic; it was hoped that its defeat would have ripple effects in other segments of the health sector, including improved health outcome, considerate treatment of black patients and doctors alike, and fully integrated medical societies and hospitals.
Medical civil rights strategists also took a less conventional path toward complete desegregation in hospitalization and health with the Imhotep National Conference on Hospital Integration.83 Imhotep was an organization formed by members of the NMA, the NAACP, and the Medico-Chirurgical Society of Washington, D.C.—a local medical society composed of African American physicians of which Cobb was a leading member—with the shared goals of “the enactment of laws to render segregated practices illegal; the filing of court suits to end the use of public funds for the construction and/or maintenance of segregated projects; and the use of persuasion on the administrative front to achieve the elimination of discriminatory patterns.”84 Over several years, the group organized chapters in other parts of the country, each charged with keeping the cause of hospital desegregation alive in their local media and with their local political representatives.85
In 1956 Cobb and Cornely, his colleague from the public health school at Howard University, planned the group’s first national conference. The conveners hoped to gather a critical mass of professionals, activists, and public officials committed to working toward healthcare integration to bring their respective regional experiences to bear on the tactics of the desegregation campaign. The conference continued annually for seven years, though support for it declined steadily after the first gathering. However, as the historian David Barton Smith notes, the conference, despite its attendance, was not without influence on the “integration battlefront”: for the duration of its existence, Smith argues, the Imhotep meeting kept the idea of hospital integration in national circulation. Furthermore, in its final years, it succeeded in attracting the support and attention of President John F. Kennedy, who sent a telegram to Cobb on the eve of the sixth annual conference to declare his support of its aims, as well as that of other politicians such as New York Senator Jacob Javits and Michigan Representative John Dingell, who introduced a bill to eliminate the discriminatory section of the Hill-Burton Act in this same year.86 In 1964 President Lyndon B. Johnson renewed an amended Hill-Burton Act that included an antidiscrimination clause. Cobb, in his capacity as president of the NMA, was at the president’s side when the modified act was signed.87
The change in the Hill-Burton Act was also the result of successful litigation by the medical civil rights movement. The NAACP Legal Defense Fund, which had already begun building a series of lower-court rulings that culminated in the Brown v. Board decision, served as counsel in medical civil rights movement lawsuits, arguing the separatebut-equal clause of the Hill-Burton Act was in conflict with the Fifth and Fourteenth Amendments and was thus unconstitutional. The most important of these cases, Simkins v. Cone Memorial Hospital, was brought before a lower court in Greensboro, North Carolina, by the dentist George Simkins, who had a patient with an abscessed tooth that required immediate medical attention.88 Simkins was unable to get care for this patient at the filled-to-capacity local black hospital or at any of the hospitals primarily serving whites in Greensboro.
Frustrated by this encounter, he contacted the NAACP, which took the case; other local black physicians and dentists signed on as plaintiffs. The plaintiffs’ attorney argued that because Cone Memorial and another local facility, Long Hospital, had been built or renovated with Hill-Burton funds, their policies were subject to the equal protection mandates of the U.S. Constitution. Despite the support of U.S. Attorney General Robert Kennedy, who filed an amicus brief on behalf of the plaintiffs, a lower court ruled against them in 1962. When the Fourth Circuit Court in Virginia heard the case on appeal, the lower court decision was reversed, and the separate-but-equal clause of Hill-Burton used to bolster discrimination at Walker and Long Hospitals was declared unconstitutional. In a final appeal, in March 1964, the U.S. Supreme Court refused to hear the case, leaving the circuit-court ruling in place.
A milestone in the integrationist health activist strategy, the Simkins case, which unfolded in parallel with political debate on Capitol Hill over federal civil rights legislation, served as a symbolic tool for legislators and government officials seeking public and political support for laws to aid the goal of integration. In testimony before a congressional subcommittee assigned to consider the matter, Secretary of Health, Education, and Welfare Anthony Celebrezze mentioned that the plaintiffs’ cause had been supported by the Kennedy administration and that the case was soon to be heard on appeal. In later supporting materials, the attorney general’s office noted that the lower-court decision in Simkins had been reversed and argued that this ruling gave support to national legislation to eliminate all separate-but-equal provisions in federally funded programs and institutions. In March 1964, on the Senate floor, Senator Javits opined that the U.S. Supreme Court decision to let the Fourth Circuit Court decision stand lent further credence to ending federally backed segregation embodied in Title VI of the Civil Rights Act of 1964, which was signed into law later that year. Therefore Simkins was as important to the cause of integration in the healthcare sector as Brown v. Board was for civil rights more generally and also a landmark contribution to U.S. health activism.
Whites-only professional associations, however, proved much more resistant to the course of medical inclusion. Through the 1960s, medical societies of physicians, dentists, and nurses were private entities that did not receive public funding and, therefore, could not be bound by the courts to integrate their memberships. Thus health activists utilized politicking and moral persuasion to integrate these professional organizations. To some degree, the benefit of these efforts flowed to minority health professionals who, in achieving integration, also improved their educational opportunities, professional prestige, and wages. However, this tactic also promised to potentially curb the mortality and morbidity rates of African Americans because these African American physicians, dentists, nurses, and others were often the first responders to the health needs of black communities.
Indicative of the racial discrimination embedded in professional practices and challenged by health activists were struggles to integrate two of the most important organizations for medical professionals, the American Medical Association (AMA) and the American Nurses Association (ANA).89 Both the AMA and ANA prohibited individual membership for much of their early history. This requirement was exploited in the early twentieth century by feeder medical societies on the local level in the Jim Crow South that used this stipulation to justify excluding black health professionals.90 That is, a health worker had to join a local society in order to be able to join the AMA; direct individual membership in the AMA was not permitted.91 This professional discrimination had serious repercussions for black doctors and nurses, who were often required to be members of the national organizations in order to be granted hospital privileges and who needed these memberships for professional development opportunities.92
While the ANA gradually desegregated in the early twentieth century, it was not until the late 1960s that the AMA leadership began to work proactively with local chapters to move toward full integration of the organization. Immediately prior to this decision, the AMA had been subject to increased lobbying from the NMA, the NAACP, and the MCHR. Although the AMA leadership was willing to pass resolutions stating that the body did not discriminate, and did so well into the 1960s, it demurred when asked to take a hard line against segregation and refused to penalize or sanction local affiliates that excluded black doctors. In response, in early June 1963, the MCCR demanded that the AMA be more forthright in its opposition to its affiliate members’ exclusionary practices and more active in intervening in other spheres of the healthcare field in which discrimination was still prevalent.93 Finding the AMA response to their requests inadequate, MCCR members—including black and white physicians and other medical workers—picketed the AMA’s 1963 annual meeting. They also protested at the AMA headquarters in Chicago some weeks after the convention, this time collaborating with the NAACP, which was holding its annual meeting in that city and was engaged in its own medical civil rights campaign begun years earlier.94 In 1965 with the AMA still segregated, two hundred protestors from the MCHR turned out at the annual AMA meeting in New York City; twice as many MCCR members and their allies protested at the AMA 1966 meeting held in Chicago. In 1966 the AMA agreed to work more closely with its southern affiliates to ensure that constituent societies adhered to the antisegregation rules of the AMA charter. Over time, the social climate changed so that it was untenable for even the most recalcitrant local medical associations to bar black physicians and other doctors.95
The ANA took a less gradualist approach to integrating its ranks, and much of the motivation to do so more quickly than the AMA came from the leadership of black women at the helm of the National Association for Colored Graduate Nurses (NACGN). In the first decade of the twentieth century, leaders in the nursing profession attempted to standardize the training and licensing of nurses. As the historian of nursing Darlene Clark Hine argues, however, these admirable goals had differential results: “The professionalization process raised the overall status of nursing, but in so doing it created a number of problems for black practitioners. . . . [African American nurses] quickly discovered that the application of these new laws and requirements erected additional barriers to their own professional advance.”96
In 1908 African American nurses formed an alternative professional organization, the NACGN, in response to their marginalization by the ANA.97 Hine argues that NACGN members sought to “achieve a modicum of status as professionals” and to gain “authority for their own personal and professional advance.”98 From 1934 until the late 1940s, Mabel Staupers and Estelle Riddle (NACGN executive secretary and president, respectively) “invest[ed] themselves totally in the quest for . . . elusive professional integration,”99 and in the process improved professional status and working conditions for black nurses.
Beginning in the early 1940s, the ANA and the NACGN worked toward removing the barriers in nursing that made distinct professional bodies organized along racial lines necessary. Their cause was aided somewhat by the ratification of the Bolton Bill, which included provisions for the federal funding of nurse training beginning in 1943 and included an antidiscrimination clause: no hospital or school receiving Bolton funding could refuse to admit black nurses.100 In addition, the profession had taken small steps toward integration of the nursing corps employed in World War II. At its 1948 national convention, the ANA approved a plan to short-circuit the discriminatory practices of southern nursing societies.101 By 1951, and more than a decade before the AMA took significant strides toward full integration, the NACGN voted to disband and publicly announced that American nursing was desegregated and that a separate organization was no longer necessary.102 (In a reversal of sorts in 1971, however, African American members of the ANA established the National Black Nurses’ Association to continue the work of securing the professional status of African American nurses in the postintegrationist era and in a new climate of racial and gender marginalization.)103
The Politics of Knowledge
The third tactic utilized by black health activists was the politics of knowledge. This approach had two emphases: the first is internal to scientific knowledge and concerns health activists’ challenges to inaccurate or biased biomedical theories about black bodies. The second is extra-scientific and involves activists’ recognition that the knowledge claims of biomedicine are often related to discrimination outside the healthcare sector. Primarily—though not exclusively—intellectuals and scientists, these early-twentieth-century health advocates challenged theories of black biological inferiority in medicine. The politics of knowledge was a necessary complement to health activists’ tactics of institution building and integrationism because it addressed some of the ideological underpinnings of medical discrimination.
Historically, disease has been linked to racial hierarchization.104 A predominant idea linking race (blackness) and disease was “sociomedical racialism.”105 A hybrid of social Darwinism and popular or “folk” understandings of race, supported by scientific authority, these theories held that blacks had a biological distinctiveness that made them more susceptible to disease.106 Sociomedical racialism was reinforced by a “crescendo of statistics” collected by state agencies during the first two decades of the twentieth century and gave credence to the notion that “blacks posed a major public health menace.”107 Two issues were at stake in this theory: it affected not only the possibility of securing adequate healthcare for blacks but also the use of biomedical knowledge to legitimatize their second-class social status.
In the early twentieth century, most black physicians were well aware that they were almost powerless against racialism. They considered the racial susceptibility debate to be a waste of time and focused their efforts on the urgent and practical issue of improving their communities’ health using the strategies of institution building and integrationism.108 Yet, these reservations notwithstanding, others believed that challenging sociomedical racialism on its own terms might have the pragmatic benefits of combating claims used to justify racist practices in the healthcare sector and beyond it. As McBride describes, the first few decades of the twentieth century “witnessed the rise of a small cadre of black medical specialists who were important contributors to the theoretical and clinical movement against medical racialism” and who “lashed out at the idea of black constitutional inferiority.”109 These doctors, social scientists, and reformers—professionals with both the knowledge and credentials to challenge the racialism in mainstream medicine—mounted a campaign of critique and counterinterpretation—a politics of knowledge—in specialist journals, the press, and civil rights–oriented publications.110
The politics of knowledge was a pillar of black health activism; as a response to sociomedical racialism, this tactic often took the specific form of “recontextualization.” In an essay titled “Appropriating the Idioms of Science: The Rejection of Scientific Racism,” Nancy Stepan and Sander Gilman discuss how Jewish and African American intellectual activists challenged racial science. They identify recontextualization as an important political device toward this end.111 Recontextualization refers to the creation of a “scientific counterdiscourse” using positivist reasoning to “prove that the supposed factual data upon which the stereotypes of racial inferiority were based were wrong,” to generate “new ‘facts,’” or to scrutinize the standard “explanation of the facts.”112 The intellectual challenges advanced by the Howard University dean and mathematician Kelly Miller and the pathbreaking sociologist W. E. B. Du Bois—in response to biased research on black mortality rates—exemplified this approach.
In 1896 Frederick L. Hoffman, an autodidact statistician, published Race Traits and Tendencies in the American Negro, a study commissioned by the Prudential Insurance Company. In this study, characterized by the historian Beatrix Hoffman (no relation) as the “most influential scientific racist tract of its time,” claimed that mortality rates of American blacks were higher than those of whites owing to their racially weak biological inheritance and the ill-effects of emancipation (for which blacks were presumably unprepared).113 She argues that this report “appealed to an American insurance industry that sought to identify poor risks for life insurance.”114 Frederick Hoffman’s claims legitimized discrimination in insurance for blacks who, having been constructed as susceptible to disease and death and therefore, a capricious investment, could be denied coverage or overcharged for it. Miller and Du Bois countered Hoffman’s report with data and analysis that exposed both its empirical weaknesses and its barely veiled racism. Miller assembled his own statistics to demonstrate that, far from dying off, the black population was growing and that the birthrate of blacks was increasing at a greater rate than that of white Americans in some cities. Additionally, Miller reevaluated Hoffman’s data comparatively and found that the high rates of tuberculosis among blacks cited by Hoffman as evidence of looming black extinction were comparable with those of white workers in Europe. Miller concluded that “high rates of disease and death were a function not of innate racial susceptibilities but of social conditions” in the United States and Europe.115
Du Bois’s critique ran along similar lines. For his part, the sociologist exposed the incomplete nature of Hoffman’s study, including contradictions in how and which data were assembled. Hoffman made claims about African Americans’ supposed propensity to illness (and subsequent mortality) on the basis of records from a few cities in the United States. At a time, in the early twentieth century, when a significant portion of the black population still lived in rural regions rather than in cities and those living in urban settings in aggregate fared better than Hoffman’s report suggested, Du Bois declared these data as woefully incomplete. Du Bois excoriated the limitations of Hoffman’s work with an instructive European analogy. He wrote:
Of course no careful student would think of judging the death-rate of Germany from that of Munich, or of arguing that an increase in the death-rate of Paris showed an increase in the death-rate of France. Yet Mr. Hoffman commits very similar mistakes; he bases his arguments as to the threatened extinction of the Negro almost solely on city death-rates, and argues that an increase in these death-rates means an increase in the general Negro death-rate. Such logic would be erroneous, even if Mr. Hoffman proved that, following the recent rush of Negroes into cities, their death-rate there had increased. Even this point, however, the author assumes on insufficient proof.116
Du Bois also confronted the arbitrariness of the American racial categories. The investigation of black well-being to which he contributed and that he also edited, The Health and Physique of the Negro American, was another example of recontextualization deployed as a politics of knowledge. Published in 1906, it was the eleventh part of an eighteen-volume series of proceedings from conferences convened by Du Bois at Atlanta University on various aspects of African American life, including poverty, employment, entrepreneurship, religion, education, and class. Health and Physique was among the first sociological studies of black health and of African American life, more generally.117 In the preface to the volume, Du Bois assembled theoretical, craniometrical, and sociological data to calibrate the health status and physical condition of American blacks. Before examining the quantity and quality of black doctors, pharmacists, and healthcare and training facilities, Du Bois exhaustively deconstructed prevailing social scientific—predominantly anthropological—theories of race and biological fitness. These were not simply abstract theories but models of difference that Du Bois felt had significant bearing on both the corporeal and social well-being of African Americans. In his words, the study took up the issue of “the physical condition of Negroes, but enlarge[d] the inquiry beyond the mere matter of mortality.”118 Du Bois showed that processes of racialization were explicitly linked to health and medicine in this period and also the degree to which the stakes of the politics of knowledge were more than physical fitness. “Health” signified both physical and social well-being and served as a site for his antiracist politics.
In Health and Physique several interpretive interventions were made. First, Du Bois outlined major conceptualizations of race, theories of racial hierarchy, and the biometric techniques that undergirded some of these. In rebuttal, he presented his own methodologically similar studies of one thousand students at the Hampton Institute, a historically black college in southern Virginia.119 Armed with this data (taken from a sample purposely larger than any past surveys in which the authors claimed to provide evidence of black biological inferiority), Du Bois challenged racially based craniometric studies—many performed by white southern physicians, including most notably Samuel Morton, whose findings were discredited by Stephen Jay Gould in the Mismeasure of Man—that put forth the hypothesis that blacks were biologically inferior owing to their supposed low cranial capacity relative to that of whites.120 Du Bois pointed out the illogic of such theories in the face of the diversity of “Negro types” resulting from generations of “race-mixing” and slavery. This history, Du Bois implied, rendered the categories of black and white arbitrary, at best. Then, stressing the importance of social variables, Du Bois contended that research that linked race and brain mass was flawed in that it took “almost no account . . . of age, stature, social class, occupation, nutrition, and cause of death; each which separately or all together affect both the weight and structure of the brain.”121
In Health and Physique Du Bois (and his colleagues) also turned their attention to the pragmatics of black health, taking up the excessive rates of black morbidity and mortality. Based on a strategy similar to that used by Miller several years prior, the study revealed that the black community’s most prevalent health problems were a function of poverty and social deficiencies rather than inherent racial frailty. Du Bois wrote: “The undeniable fact is, then, that in certain diseases the Negroes have a much higher rate than the whites, and especially in consumption, pneumonia and infantile disease. . . . The question is: Is this racial? . . . the difference in Philadelphia can be explained on other grounds than upon race.”122
Du Bois and his collaborators did not so much question morbidity and mortality rates as reinterpret their significance. At this time, consumption (tuberculosis) was the most deadly epidemic facing black communities.123 Compiling evidence from vital statistics offices, the Bureau of the Census, U.S. Army recruiting examination records, and life insurance companies, among other sources, and (like Miller) comparing these data with comparable figures among working-class whites in major U.S. cities and in Europe, the study concluded that tuberculosis “was not a racial disease but a social disease” linked to poverty, housing conditions, and working conditions.124 In reexamining existing information on tuberculosis rates, Du Bois and his colleagues produced evidence that high rates of the epidemics among blacks were a function of the disproportionate numbers of blacks living in poverty, inhabiting substandard housing, or working jobs with high risks of exposure. Turning his attention to infant mortality and using similar methods of analysis, Du Bois concluded that the high frequency of childhood deaths in the black community “was not a Negro affair, but an index of social conditions.”125
In addition to the strategies of reinterpretation evident in Health and Physique, this multifaceted study was important because the authors, through their approach to the health of American blacks, introduced many of the themes taken up in future health activist projects, including those of the Black Panther Party. They dealt with the issue of health institutions: the quantity and quality of medical facilities for African Americans; and medical training schools for black physicians, nurses, and dentists. They made healthcare access and what are now termed racial health disparities a key cause of concern, even as they questioned links between blackness as a racial category and biological inferiority. They articulated that poverty and social marginalization were the causes of black illness and implied as well that racism was a correlate of this community’s compromised mortality and morbidity rates.
Across the twentieth century, African American health activists applied a panoply of strategies to improve black well-being. The use of the tactics of institution building, integrationism (or inclusion), and the politics of knowledge were vital to this undertaking. The employ of these three often overlapping interventions reflected the unique stakes of health activism for blacks for whom the domains of health and medicine had been zones of dominance and de jure exclusion, with potentially life-threatening consequences.
As subsequent chapters elaborate, the Black Panther Party’s health politics reflected the tactical approaches described in this chapter. While the Panthers’ activism surfaced after formal desegregation was accomplished, racial discrimination, economic inequality, and forms of de facto segregation endured. As a result, the Party’s tactics reflected the influence of this prior tradition of African American health activism, even as the organization ventured in new directions. The Party deployed the politics of knowledge, for example, to recontextualize scientific and social scientific information about sickle cell anemia and genetics research. This approach, in which social explanations were often counterposed to scientific or epidemiological explanations or alternately used to make them more robust, prefigured the Panthers’ social health perspective. Also central to the Party’s efforts was an emphasis on demystifying biomedicine and medical expertise and the concomitant valuing and developing of black community participation. Its network of neighborhood-based health clinics exemplified institution building. Working in this vein, moreover, the Panther organization borrowed from a long history of black health politics and also bridged to the more immediate health initiatives of SNCC. Lastly, surprising for an organization that came to be characterized by its strident and audacious resistance to the status quo, the Black Panthers also sought inclusion into mainstream medicine; much like its ventures into electoral politics, the Party would at times seek to change the medical–industrial complex both from within and from without. As the next chapters describe, the Party mobilized many lines of attack to dismantle forms of medical discrimination and to foster social health for the black poor.