Defining Moments and Figures in the History of Black Health
BLKHLTH seeks to inform people about race-based health disparities and engage the community in the process of creating change and advocating for health equity. This mission isn't new. Black people have been working and advocating for equal access to quality healthcare and health promoting resources throughout time. In this article, each co-founder of BLKHLTH provides an overview of a person or movement important to black health.
Bobby Seale and The Black Panther Party
Bobby Seale is the co-founder of the Black Panther Party and an advocate for the social welfare of African Americans. Under the guidance of Bobby Seale, the Black Panther Party began several social programs to improve health and health related outcomes for black people. The Party demonstrated an understanding of the social determinants of health before the concept became common in the public health lexicon. The Party understood that racism, the subsequent race-based segregation, and poverty were all social determinants that restricted Black people’s access to quality health protective resources like fresh fruits and vegetables and social programs.
The Party began to implement public health interventions, rooted in the African American cultural context, that circumvented many of the barriers faced by black people. Two of the well-known programs include the Free Breakfast for School Children Program and The People’s Free Medical Clinics. The Party’s breakfast campaign served over 20,000 kids a week. The clinics, staffed by volunteer doctors, nurses, and medical students, provided treatment services, education, and preventative screenings for well-known disorders with prevalence high in African Americans (like sickle cell). There were clinics in thirteen cities across the country.
Although the Black Panther Party was officially disbanded in 1980s, their ideology on community-based solutions and public health should not be forgotten. Bobby Seale is a still a social advocate continues to speak around the country on social justice and black liberation.
Rwanda has Universal Health Care – and it’s Working
The East African country of Rwanda has had universal health coverage since 2008, when health insurance became mandatory for all Rwandan citizens. It is no small feat that this country went from a nearly decimated economy and healthcare system after the 1994 genocide to having one of the best healthcare systems in the region just two decades later. Immense credit is due to the Rwandan government’s decision to prioritize health as a key factor in alleviating poverty and driving development.
Mutuelles de Sante (Mutual Health) is Rwanda’s community-based health insurance program. The program works using a sliding scale; the wealthiest Rwandans pay about $8 a year in premiums while the poorest 25% of Rwandans get free care. These premiums go into a larger local health fund that people can use to subsidize their care and clinics can use for their daily operations. The Mutuelle system has dramatically increased the number of people accessing health services and now health centers, in both urban and rural areas, have the ability to pay staff and buy equipment. Universal health coverage has been so successful that currently only 4% of Rwandans are uninsured and Rwandans go to the doctor almost twice a year on average, compared to once every four years in 1999.
“It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, the former Minister of Health who turned health in Rwanda around with her belief that health care is a human right for all. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things – this is very important in trying to stimulate economic development.”
Dr. Marilyn Hughes Gaston
Sickle cell disease affects 1 in every 365 black children. If undiagnosed at birth, sickle cell disease can cause sudden death due to bacterial sepsis (bacteria in the bloodstream that results in infection) within the first few years of life. However, thanks to Dr. Marilyn Hughes Gaston - a black woman from Cincinnati, Ohio - the standard of care for infants born with sickle cell disease was changed forever, causing a reduction in the rates of morbidity and mortality for those born with the disease.
Dr. Gaston developed a passion for improving the health of her community at an early age when her mother fainted due to complications from undiagnosed cervical cancer. It was at that moment she knew she “we were poor, we were uninsured, she was not getting health care, ...and that's why she fainted. And from that point on, I knew that I wanted to do something to change that situation.” She went on to pursue an education in medicine, despite the attempts from others to discourage her. In 1964, she graduated from the University of Cincinnati School of Medicine, where she was the only African American woman in her class. Marilyn completed her internship at Philadelphia General Hospital where she first developed her interest in sickle cell disease.
However, it wasn’t until 1986 when Dr. Gaston published a study that changed the way infants born with sickle cell disease were treated. Knowing that many would die suddenly from bacterial sepsis, Dr. Gaston and her colleagues found that administration of oral penicillin twice a day would cause an 84% reduction in the incidence of infection. This discovery lead to the implementation of universal sickle cell disease screening for newborns to allow for the administration of this life saving intervention.
Dr. Gaston went on to become the first African American woman director of a Public Health Service bureau (Bureau of Primary Health Care in the U.S. Health Resources and Services Administration) and championed the “Movement Toward 100% Access and 0 Health Disparities”. Through her research and numerous leadership roles, Dr. Marilyn Hughes Gaston did exactly what she sought out to do, change and improve the health of her community.
The Rise of the Black Hospital and Racial Desegregation of Healthcare in the United States
Following the Civil War, Black clinicians and patients faced tremendous disparities in access to both medical education and medical treatment. These barriers to care and education were particularly apparent in the Jim Crow South, where racist Black codes and the fallacy of separate but equal reign supreme. Black students interested in pursuing a career in medicine were barred from attending most medical schools and many Black physicians were not granted admitting privileges to white-serving hospitals. Similarly, many Black patients were faced with substandard Black-only healthcare facilities (which were white owned and operated), while many others were permitted into white-serving hospitals under the requirement that they were separated from white patients.
In response to the racist practices hindering Blacks from accessing quality healthcare services and education, Black health professionals and advocates banned together to form their own institutions to train and serve the Black community. Prominent Black medical societies like the National Medical Association (NMA) emerged to help improve medical education programs for Black clinicians. Black owned and operated hospitals like the Homer G. Phillips Hospital in Saint Louis and Provident Hospital in Chicago were created to provide high quality healthcare services to Black patients. At its height, there were roughly 500 Black owned or operated hospitals in the US that primarily served the Black community.
African-American physicians and the NAACP fought tirelessly for equal quality healthcare institutions for Blacks. This advocacy helped make the Hill-Burton Act of 1946 possible, which provided federal funding for hospital improvement activities and required hospitals receiving this funding to provide equal treatment to all patients regardless of race. However, the Hill-Burton Act included a separate but equal provision and many Black physicians were not granted privileges to treat Black patients that entered Hill-Burton funded hospitals. The NAACP decided to challenge the separate but equal provision in the Hill-Burton Act and lawsuits were filed against hospitals unwilling to grant Black physicians admitting privileges. In February of 1964, the case of Simkins vs. Moses H. Cone Memorial Hospital was brought to the Supreme Court after the appeals court ruled in favor of the plaintiffs. The Supreme Court declined to review the case, the appeals court ruling stood, and hospitals receiving Hill-Burton funds were officially ordered to desegregate. Subsequently, in the summer of 1964 the Civil Rights Act was passed, which banned racial segregation all together. While this was a win in many regards, it is important to note that this was also a huge loss for Black owned and operated hospitals, which quickly began to dismantle post-integration.
One cannot deny that the effects of systematic oppression still negatively impact healthcare access and quality (and ultimately health outcomes) for African Americans to this day. However, the groundbreaking work that our predecessors made in progressing racial health equity can not be ignored. This work has been the precursor to some major laws that have beneficially impacted the health of the Black community in recent years. One of those laws, the Affordable Care Act of 2010, was passed under our first Black president and has cut the uninsured rate of African Americans by one third through Medicaid expansion and increased access to preventive health screenings. And beyond federal policies, the work of these courageous Black health pioneers proves the power of coming together as a community to help move the needle towards racial health equity.