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

Conclusion. Deluxe Jim Crow in Education Versus Health Care

|| 266 || conclusion Deluxe Jim Crow in Education versus Health Care T The act of separation and the act of segregation in and of itself denies [black schoolchildren] equal educational opportunities which the Fourteenth Amendment secures. Here we abandon any claim . . . of any constitutional inequality which comes from anything other than the act of segregation itself. Robert Carter, attorney for the plaintiffs in Brown v. Board of Education of Topeka, Kansas, December 9, 1952 he rise and fall of the ideology of equalization among both blacks and whites provided the backdrop for racial change during the era of deluxe Jim Crow. Beginning in the 1930s, the southern movement to equalize black and white schools was black-led (primarily by the National Association for the Advancement of Colored People [naacp]), never secured federal funding, and garnered only lukewarm commitment at the state level from whites primarily bent on protecting segregation. Blacks, however, gave educational equalization their wholehearted support: the Louisiana Farmers’ Union, for example, endorsed the Harrison-Fletcher Bill in 1938. The Farmers’ Union agent who testified at the Senate hearings heard from a member who wrote that aid for rural schools was “one of the most important things you could have done for us especially in West Feliciana Parish.” By contrast, even the southern Senate sponsors who coveted regional equalization of education balked at the price of education versus health care || 267 || threatening segregation. But white self-interest in black health was much greater than in black education because, unlike illiteracy, most forms of disease were still contagious. Moreover, white employers had far more motivation to keep the black labor force free of sickness than of ignorance, since improved skills and knowledge might help blacks to compete with white workers or organize for better wages and working conditions.1 Equalization in education was motivated almost solely by whites’ desire to quarantine rather than improve black education; increasing black health-care accessnotonlydeflectedattacksonsegregationbutalsoservedavarietyofother, broader purposes that sustained white commitment over several decades. Until the 1930s, the South’s hospitals had been as racially separate and unequal as its schools, except that in many rural communities, no hospital existed for either race. But white medical schools needed patients for clinical training, so teaching hospitals were often constructed near large indigent black populations and served both as volume providers of charity care and as referral centers for the surrounding region. The greater expense and increasing technological requirementsofhealthcaredrovecost -consciouswhitepolicymakerstoeschewwasteful duplication and build more efficient facilities that were shared by both races. Ironically, public policy in hospital construction built small biracial hospitals in ruralareas,whileineducation,theschool-consolidationmovementgatheredruralstudentsintolarge ,comprehensiveschoolsbutcontinuedtoseparatethemby race. In addition, the rationale of rural and regional uplift in health emphasized the universal benefits of federal aid to the South and defused whites’ concerns aboutracialconflict,whereasthenaacp’sleadershipofthecampaigntoequalize southern education inherently threatened most southern whites. Equalization in education attempted to address both school facilities and teacher salaries but failed on both counts. In contrast, equalization as implemented in health care emphasized facilities construction and the extension of public health services but did not guarantee equal compensation or even staff privileges for black medical professionals, which had been precisely the goal of the earliest proposed nondiscrimination clauses in federal health legislation. Because the success of equalizationinhospitalcarewasconditionedonmaintainingwhitecontrolover its administration, equalization benefited black patients much more than black professionals. Although black doctors and especially nurses gained a foothold in white-run hospitals, the staffs at many hospitals that had received federal construction funds remained all-white into the 1960s. For example, Atlanta’s || 268 || conclusion Grady Memorial Hospital did not admit a black intern to its staff until 1963 and did so only under threat of a lawsuit. The hospital continued to separate black and white patients within its walls until 1965.2 During the first two decades of federal aid to hospital construction beginning in 1933, the vast majority of existing black hospitals did not receive assistance. By raising the physical and technological standards for hospitals in the postwar era, Hill-Burton and its predecessors sped the demise of black hospitals, which typicallyranonshoestringbudgetsandboretheburdensofoutdatedequipment and aging physical plants. At first glance, the attrition of black hospitals parallels the mass closings of black schools in the decades after Brown. When southern officialsattemptedtodesegregatepubliceducation,theywereforcedtoadaptthe completely separate and grossly unequal buildings of black and white schools in each district. Black high schools that remained open were usually repurposed to accommodate middle or elementary students, resulting in the loss of cherished sources of...