Deluxe Jim Crow: Civil Rights and American Health Policy, 1935–1954 by Karen Kruse Thomas (review)

Deluxe Jim Crow examines the struggles of black civil rights activists, public health officials, and liberal southern politicians to address racial health disparities during the Roosevelt and Truman eras. In their efforts to provide medically underserved African American communities with expanded access to health-related federal funding, reformers embraced what Thomas describes as a “devil’s bargain,” adopting an ethically complex system that significantly reduced racial health disparities but which left the principle of segregation intact. By framing health reform as critical to the nation’s economic well-being and military defense—rather than as a campaign for racial equality—advocates were able to accomplish a series of legislative measures, culminating in the Hill-Burton Act of 1946, which provided for the construction of biracial hospitals, modern medical facilities with segregated wards. While not explicitly aimed at the alleviation of racial health inequalities, reformers required that funding for such institutions be distributed according to a need-based formulation and included a substantive “nondiscrimination” clause, mandating a degree of racial parity in the allotment of funds and hospital provisions. Through this system of “deluxe Jim Crow,” reformers found a means to provide valuable medical resources to impoverished African Americans suffering from debilitating conditions throughout the South. Although the practice of segregation remained, their reforms proved remarkably successful at improving the health of African Americans and reducing racial disparities during the time period.

Deluxe Jim Crow is a rich study into the contours of racial health and the nuances of health care activism and policy in the mid-twentieth century, issuing a number of provocative and compelling challenges to oft made assumptions about the nature of racial disparities. Among her most notable claims, Thomas illustrates that health inequalities bore closer resemblance to regional, socioeconomic, and rural–urban demographics than to racial differences. At a time when the South was often characterized as the nation’s leading health problem, Thomas writes that “southern blacks and whites were more similar than different [in matters of health] and also more similar to each other than to their northern same-race counterparts” (31). Without diminishing the “myriad deleterious social and psychic effects” of Jim Crow, Thomas contends that legally sanctioned segregation “was not the principal cause of racial disparities in health” (265). Rather, with a disproportionate percentage of African Americans included among the southern rural poor, it was the combination of “racism, poverty, and geographic isolation” (43), aggravated by severe economic crisis, that led to the increase, or “telescoping,” of health disparities. By focusing on these regional and socioeconomic factors—rather than pursuing integration as a proverbial “magic bullet” to eradicate health inequalities—reformers were able to craft politically pragmatic policies that brought African Americans significant health benefits.

In addition to its appreciation for the complex factors shaping racial health and policy reform, Deluxe Jim Crow pushes for more nuanced interpretations of the motives and intentions of federal agencies and health care reformers who served during this era. Thomas challenges popular depictions of the United States Public Health Service (PHS), known largely for its role in the Tuskegee Syphilis Study, as uninterested in the health and well-being of African Americans. To the contrary, she shows how the PHS, under the leadership of Surgeon General Thomas Parran, established a reputation as “the most problack” (75) of all federal agencies. In line with its larger mission to improve public health, the PHS facilitated meaningful collaborations between black and white medical organizations, federal and southern agencies, philanthropic foundations, and academic institutions in order to better address African American health care needs. Thomas offers similar revelations about the racial attitudes of influential education reformer, Abraham Flexner, and reevaluates the roles black medical schools and black practitioners played in the alleviation of health disparities. By challenging reductionist platitudes that tend to neglect...