An American Health Dilemma

A Medical History of African Americans and the Problem of Race: Beginnings to 1900

W. Michael Byrd, Linda A. Clayton

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135960483
• Edition: 1
• Topic: Geschichte
• Subtopic: Weltgeschichte

At times mirroring and at times shockingly disparate to the rise of traditional white American medicine, the history of African-American health care is a story of traditional healers; root doctors; granny midwives; underappreciated and overworked African-American physicians; scrupulous and unscrupulous white doctors and scientists; governmental support and neglect; epidemics; and poverty. Virtually every part of this story revolves around race. More than 50 years after the publication of An American Dilemma, Gunnar Myrdal's 1944 classic about race relations in the USA, An American Health Dilemma presents a comprehensive and groundbreaking history and social analysis of race, race relations and the African-American medical and public health experience. Beginning with the origins of western medicine and science in Egypt, Greece and Rome the authors explore the relationship between race, medicine, and health care from the precursors of American science and medicine through the days of the slave trade with the harrowing middle passage and equally deadly breaking-in period through the Civil War and the gains of reconstruction and the reversals caused by Jim Crow laws. It offers an extensive examination of the history of intellectual and scientific racism that evolved to give sanction to the mistreatment, medical abuse, and neglect of African Americans and other non-white people. Also included are biographical portraits of black medical pioneers like James McCune Smith, the first African American to earn a degree from a European university, and anecdotal vignettes, like the tragic story of "the Hottentot Venus", which illustrate larger themes. An American Health Dilemma promises to become an irreplaceable and essential look at African-American and medical history and will provide an invaluable baseline for future exploration of race and racism in the American health system.

PART I

The Background

CHAPTER ONE

Race, Biology, and Health Care in the United States: Reassessing a Relationship

Race is a major factor in American life. Of all the factors that adversely affect the health status and outcomes of African Americans, race is one of the major contributors. The roots of the problem can be traced back thousands of years to the very origins of Western life sciences and the health subculture. But racial effects on health outcomes are often ignored and obscured by the very medical and health establishments that purport to aid those afflicted. So impressed were Louis Knowles and Kenneth Prewitt with the effects institutional racism had on the health and health care of African Americans that they included a chapter, “Why White Americans Are Healthier,” in their pioneering book Institutional Racism in America (1969). The federally sponsored Kerner Commission Report of 1968, the Report of the National Advisory Commission on Civil Disorders, also cited the absence or inadequacy of health care based on race as one of the major precipitating factors in the epidemic of urban race riots sweeping the United States during the 1960s. Only now are medical and health policy researchers beginning to reexamine earlier assumptions.

During the 1980s a team led by leading health economist Eli Ginzberg conducted surveys and investigations focusing on the public health care sector (city and county hospitals, hospital and public clinics, and health departments) in a representative sample of the nation's major cities. Their conclusions were startling. African American and other economically disadvantaged groups disproportionately utilized the public health care sector for most of their health-related needs. The Ginzberg team's testimony before the U.S. Congress in 1994 indicated that health care for African Americans and the poor has not substantively changed since the 1960s and might be deteriorating.¹

To comprehend the relationship between race and health care in the United States, what is actually known about race and its relationship to biomedical and other life sciences and health care must be analyzed and exposed while examining some of the modern concepts about race in Western society. An intellectual history of race can guide our inquiry and increase understanding of what is known about the concept in Western culture. A deeper and more comprehensive reckoning of the modern relationships between race and the life sciences, along with how the contemporary relationships evolved, necessitates a historical examination. Exploring concepts of race and racism and their connections to medicine and health care in U.S. and predecessor Western cultures is a critical goal of this inquiry. Through this examination the relationship between race and Western biomedical and other life sciences can be clearly and comprehensively drawn for the first time.

Race operates in society today more explosively and confusingly than ever before. Many factors confuse and reignite this ever smoldering social issue. They include, but are not limited to, the loss of the dominant society's patience with African Americans and the Civil Rights Movement; the efficacy of the more subtle racialist mechanisms of economic and social domination and discrimination; a relatively new and modern racialist mechanism built around the erection of a European American culture-based, IQ- and achievement test-oriented “meritocracy” favoring groups with access to privileged environments and quality education and training; the emergence of political and religious conservative movements with their traditions of religious and racial intolerance; the emergence of aggressive feminist and newly empowered Latino and Asian American groups competing with African Americans for limited jobs, training and educational opportunities, and political positions previously allocated for non-Europeans and women; and the lack of political, economic, and ideological commitment by the nation's European American leaders to openly address and alleviate the impact of racism in U.S. society. All these potent forces threaten to overpower the interests of America's oldest and largest minority^* group.

For a variety of reasons, racial and ethnic polarization seems to be intensifying. How does race affect contemporary U.S. society—particularly health care? As evidenced by persistent race-based health disparities and segregation in the health care system, a new “hostile and unequal” racial climate profoundly affects African American health and health care.² (See Table 1.1.)

Table 1.1 Racial Comparison of Health Data through Early 1990s

Health Parameters	Black-White Comparison	Comments/Significance
Longevity	Blacks live 5 to 7 years less than Whites.	The “Gold Standard” of health system performance: Black males continue the free fall in longevity that started in 1984; Black-White gap widening since 1984.
	Black life expectancy 69.2 years compared to 76 years for Whites.	Black life expectancy at lowest point since 1981 and 0.4 years shorter than the 1986 edition of Table 1.1.
Excess deaths	Blacks suffer 91,490 annually; 37% of Black deaths are “excess.”	Almost 4 of 10 Black deaths are “extra”; if death rates for races were equal, these deaths wouldn't occur; excess deaths have increased 53% since 1984.
Death rate (deaths per 100,000 [10^5] population)	Black death rate of 783.1/10^5 is 1.6 X the White rate.	The ultimate sign of health system failure; misses huge amounts of morbidity (pain and suffering); death rate for Blacks now higher than 1982 rate.
Infant mortality rate (death in first year of life per 1000)	Black IMR of 17.7 per 1000 live births is 2.2 X the White rate.	A major indicator of health status and a measure of general living standards of a population; Black rate worse than Cuba's, Puerto Rico's, or Costa Rica's; Black-White disparity widening since 1970s; rose in 1989.
Death rate 25- to 44-year- olds (per 100,000 [10^5] population)	Black rate of 373.6/10^5 is 2.5 x the White rate.	Huge number of person-years lost; responsible for a larger portion of poverty and matriarchal families plaguing Black communities; Black-White disparities widening since 1982.
Selected (leading) causes of death (National Vital Statistics System)	Blacks lead in 14 of 16 categories.	Many of these deaths preventable with known, basic, cost-effective medical treatments.
Neonatal morality Black rate^a	1987-89 Black rate at 12.1/103 live births, with Black-White ratio of 2.28.	Reflects prepregnancy health and prenatal, intrapartum, and neonatal care; racial gap is increasing; the rate rose in 1989; 1989 disparity between Black and White newborn death rates at widest point since 1950.
Low-birth-weight infants (<2500 gm)	Black rate of 13.51% is 136% more than White rate.	Racial discrepancy widening; leading killer and primary source of lifelong disability; Blacks presently experiencing 1950s White rates; Black rates higher than 1980; racial disparity widening.
Very low birth weight (<1500 gm)	Black rate of 2.95% is 3.2 X the White rate.	Physical and mental handicaps often impair survivors; racial discrepancy widening in recent years; Black rate increasing for last 20 years.
Perinatal mortality rate^b	Black rate of 17.1/10^3 live births is 111% higher than White rate.	Reflects quality of obstetrical care; is a valid indication of infant morbidity.
Post-neonatal mortality (death from day 29 to 364 per 1000 [10^3] live births)	Black rate of 6.4/103 live births is more than 2 X White rate.	Reflects quality of health care for children; prevention and treatment of controlled, treatable diseases; this parameter, getting worse for past 2 years, has reached 1985 levels.
Maternal deaths by race	Black rate of 18.6/10^3 live births is 3.4 x the White rate; amounts to almost 40% of US total.	Reflects lack of access to obstetrical care; current figures probably an undercount; 75% of these deaths are preventable; Black rate higher than 1982 levels.
Immunization rates (Black children)	69.1% immunized against DPT^c; 56.5% immunized against polio by age 2 (ranks 56th internationally).	Black children still die, lose vision and hearing, and suffer brain damage from these easily preventable diseases; more children died from measles in 1990 than in any year since 1971.
Child deaths by race (deaths per 100,000 [10^5] children) Age Black 1-4 79.65 5-14 34.7	Black rate 30 to 50 percent higher than White rate. White 46.05 24.65	Many of these deaths preventable by immunizations, early diagnosis and treatment; more of these children are being locked out of the health delivery system daily.
Childhood anemia	One-fifth to one-third of Black children are anemic.	Easily diagnosed and treated with basic child care; reflects poor nutrition; adversely affects school performance.
Toxic lead levels	15-20% of Black urban children may have toxic lead levels.	The first thing lost is intellectual function; most of these children are probably undiagnosed and untreated; probably being mislabelled as retarded or “slow learners.”
Childhood tuberculosis	Blacks 4 to 5 X the White rates.	Children's health programs are being cut despite this.
Dental care	40% of Black children <17 years old have never seen a dentist.	Two-thirds of Black children haven't seen a dentist in the past year, programs are being cut daily.
Prevalence Rates
Diabetes	33% more common in Blacks.	Programs providing care for chronic diseases being cut annually.
Hypertension	Blacks: 34.05% prevalence. Whites: 20.6% prevalence.	Programs providing care for chronic diseases being cut annually.
Heart disease	1.5 X more common in Blacks.	Programs providing care for chronic disease being cut annually.
Stroke deaths	Black rate 1.93 X White rate.	Largely preventable with good, outpatient medical care; African American access for this care is declining.
Diabetes death rate	Black rate 1.43 x White rate.	Largely preventable with good, outpatient medical care; African American access for this care is declining; Black-White discrepancy widening.
Heart disease death rate	Black rate 1.43 x White rate.	Largely preventable with good, outpatient medical care; African American access for this care is declining; Black-White discrepancy widening.
HIV infection	Black Male rate 3 x White rate; Black female rate 9 x White rate.	Rose from 15 th to 11th leading cause of death; 25% of cases are in African Americans; 55.8% and 54.6% of AIDS cases/AIDS deaths respectively in children were Black between 1984 and 1991.
Pneumonia and influenza death rate	Black rate 1.5 x White rate.	Preventable by access to good medical care, treatment, and timely hospitalization; access for Blacks and the poor is being curtailed.
Nephritis, nephrosis, and nephrotic syndrome deaths	Black rate 3 x White rate.	Largely preventable with good, outpatient medical care and timely hospitalization; access for Blacks and the poor is being curtailed.
Persons unable to carry on major activity because of chronic conditions, according to race	Percent of Black Americans (5.5%) with this form of disability is 80% to 90% higher than White Americans.	This is a measure of the “walking wounded” due to illness; the B/W disparity not improving for a decade; Black rate increasing slightly since 1985.
Cancer incidence	Black: 27% increase White: 12% increase	Reflects increased environmental, toxic exposure, poor diet, and high- risk lifestyle; gap widening.
Cancer mortality increase (since 1950)	Blacks: 50% increase Whites: 10% increase	Rates were even in 1950 when there was little treatment; Black access to early diagnosis and treatment being curtailed annually.

^aNeonatal mortality refers to the death of an infant during the first 28 days of life.

^bNumber of stillbirths plus neonatal deaths per 1,000 live births.

^cDPT refers to the standard diphtheria-pertussis-tetanus immunization vaccine.

Sources:

American Cancer Society. Cancer Facts and Figures for Minority Americans: 1986, 1991. New York: American Cancer Society, 1986.

American Cancer Society. Cancer Facts and Figures—1988, 1992. New York: American Cancer Society, 1988.

Byrd WM, Clayton LA. An American health dilemma: A history of blacks in the health system. Journal of National Medical Association 1992, 84:189–200.

Children's Defense Fund. Black and White Children in America: Key Facts. Washington, D.C.: Children's Defense Fund, 1985.

Cunningham FG, MacDonald PC, Gant NF. Williams Obstetrics. 18 Edition. Norwalk, Conn.: Appleton and Lange, 1989.

Haynes MA. The Gap in Health Status between Black and White Americans. In Textbook of Black-related Diseases, edited by RA Williams, 1–30, New York: McGraw-Hill, 1975.

Jaynes GD, Williams RM. eds. A Common Destiny: Blacks and American Society. Washington, D.C.: National Academy Press, 1989.

Mahaffey KR, Annest J, Roberts J, Murphy R. National Estimates of Blood Lead Levels: United States 1976–1980: Association with selected demographic and socioeconomic factors. New England Journal of Medicine 1982, 307:573–579.

National Center for Health Statistics. Health Status of the Disadvantaged Chartbook/1990. Hyattsville, Md.: Public Health Service, 1991.

National Center for Health Statistics. Prevention Profile. Health United States, 1991. Hyattsville, Md.: Public Health Service, 1992.

National Center for Health Statistics. Advance Report of Final Mortality Statistics, 1989. Monthly Vital Statistics Report; vol. 40 no. 8 supp. 2. Hyattsville, Md.: Public Health Service, 1992.

Physician Task Force on Hunger in America. Hunger in America: The Growing Epidemic. Middletown, Conn.: Wesleyan University Press, sponsored by the Harvard School of Public Health, 1985.

United Nations. Demographic Yearbook 1983–1988. New York: United Nations, 1988.

US Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health, vol. 1. Executive Summary. Washington, D.C.: US Government Printing Office, 1985.

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On Race: Examining an Enigma

A deep and probing inquiry on race is necessary for all of these reasons. One prerequisite is to factor in the effects of the centuries-old relationship between race, Western medicine, science, and health care. A core of modern scholars such as philosopher-ethicist Cornel West; social scientists Thomas Pettigrew, Paul Sniderman and Thomas Piazza, Joe R.Feagin and Melvin P.Spikes, Douglas S.Massey and Nancy A.Denton, St. Clair Drake, William Julius Wilson, Robert W.Terry, and Timothy Maliqalim Simone; social commentators like Ellis Cose and the late Marlon Riggs; and racial theorists and philosophers such as Patricia Turner and Lucius Outlaw have recently attempted to disentangle the new and complicated mix of race relations in the United States. Their efforts at clarification are often complex and challenging. For the purposes of this study, a fresh and all-inclusive investigation of the ancient classical Greek, Arabic, and Western European sociocultural and biomedical dimensions...