Deluxe Jim Crow: Civil Rights and American Health Policy, 1935-1954

2. The New Deal in Health

lthough the U.S. Public Health Service (phs) had begun to make inroads into the infectious diseases of poverty that beleaguered the South’s growing urban population and its shifting rural areas, the farm crisis of the 1920s, the catastrophic Mississippi River flood of 1927, and the hardening of segregation amid post–World War I racial unrest worsened the plight of many of the region’s most vulnerable residents. Cotton prices dropped from a high of forty cents per pound during the war to five cents per pound by the end of the 1920s, and both rural and black health initiatives stagnated in the areas hit hard and early. After visiting the cotton mill towns of Gaston County, North Carolina, in 1934, Martha Gelhorn, a field agent for the Federal Emergency Recovery Administration, expressed the fear that conditions for poor rural southerners had declined over the past generation: “The children are growing up in terrible surroundings; dirt, disease, overcrowding, undernourishment. Often their parents were farm people, who at least had air and enough food. This cannot be said for the children.” According to local doctors, conditions were so dire that it seemed “as if the people were degenerating before your eyes: the children are worse mentally and physically than their parents.” One black physician observed that the depression had caused “millions of whites [to experience] the mental and physical uncertainties which have characterized the existence of the Negro in this country for two generations.” During the early 1930s, both private and public funding of health programs decreased, and chapter 2 The New Deal in Health|| 45 || A || 46 || chapter two personal income and spending for health services reached all-time lows. Racial and regional differences in American health care widened, but the crisis also promoted greater cooperation between private-practice physicians and public health professionals.1 Inviting Blacks to the New Deal Table The National Urban League’s Opportunity magazine upheld the phs as one the few federal agencies that, even before 1933, “acknowledged the exclusion of the Negro from the normal stream of community and national life by employing Negro specialists to promote programs among Negroes to apprise the agency of the impact of social problems upon them.” Once the New Deal began, the phs’s early focus on southern, rural, and black health was expanded by an interlocking directorate of New Deal officials, southern progressive activists and politicians, blackintellectualsandreformers,andrepresentativesofphilanthropiesinterested in improving southern conditions.2 After Franklin Roosevelt’s inauguration in 1933, three key officials of the Rosenwald Fund (president Edwin R. Embree, trustee Will Alexander, and directorofresearchCharlesS.Johnson)obtainedfdr’senthusiasticapprovalfor a plan to ensure that black southerners were included in federal programs. Based on previous experience with using “Negro specialists” in phs and Rosenwald health projects, the fund provided salary support for an adviser on Negro affairs who would advocate on behalf of black interests within the administration. Secretary of the interior Harold Ickes, whose department oversaw Freedmen’s Hospital and Howard University, was “the leading standard-bearer for social changeintheearlyRooseveltyears,breakingthesegregationisticeintheInterior Department and the Public Works Administration, which he also headed.” In 1934, Clark Foreman, the young white grandson of the founder of the Atlanta ConstitutionwhohadworkedunderAlexanderattheCommissiononInterracial Cooperation and for Embree at the Rosenwald Fund, became the first federal racial adviser under Ickes. Foreman went on to serve as the lead editor of the Report on the Economic Conditions of the South and as president of the Southern Conference for Human Welfare.3 Twenty-six-year-old Robert C. Weaver, a black Harvard economics graduate , soon joined Foreman as a racial adviser in the Department of Interior and called attention to the ways residential segregation undermined public health. As the Roosevelt administration’s premier adviser on Negro affairs, Weaver the new deal in health || 47 || fought discrimination in housing, education, and employment and went on to become the first head of the Department of Housing and Urban Development under Lyndon Johnson. Other federal agencies soon appointed their own racial advisers, and the post became a fixture of New Deal social welfare programs. By 1943, blacks served in thirty senior federal posts and comprised 18 percent of all federalemployees,andaninternalRooseveltadministrationmemoreportedthat “in many important agencies, more than 50 per cent of the Negroes employed were in clerical, administrative and fiscal positions.” Historian Karen Ferguson emphasizes the New Deal’s departure from public policy’s long-standing blindness to black needs, as evidenced in the incorporation of talented...