An American Health Dilemma. Vol. 1, A Medical History of African Americans and the Problem of Race: Beginnings to 1900, and: Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (review)

W. Michael Byrd and Linda A. Clayton. An American Health Dilemma. Vol. 1, A Medical History of African Americans and the Problem of Race: Beginnings to 1900. New York: Routledge, 2000. xxviii + 588 pp. Ill. $U.S. 35.00; $Can. 52.00 (0-415-92449-9).

Keith Wailoo. Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2001. ix + 338 pp. Ill. $34.95 (cloth 0-8078-2584-0), $16.95 (paperbound, 0-8078-4896-4).

In the 1940s, Swedish sociologist Gunnar Myrdal coined the phrase "American dilemma" to replace what had previously been referred to as the "Negro problem." For Myrdal and his sponsors at the Carnegie Corporation, this was not mere wordplay; rather, it signified the emergence of a new liberal consensus in the United States. The social problems associated with race would no longer be seen as concerning only blacks. Booker T. Washington's notion of uplifting the race in segregated social and economic sphere, with the patronage of white philanthropists and in the absence of full political rights, was moribund. Instead, Myrdal suggested that all Americans had to confront the dilemma posed by the presence of second-class citizens in a nation pledged to equality under the law. Built on the foundation laid by integrationists over the previous decades, and in the context of the war against Nazi Germany, this was a powerful idea. It infused the civil rights movement of the fifties and sixties, and helped motivate people of any color to risk injury and death in the fight for equality.

What had triumphed in theory in the 1940s triumphed in law with the Supreme Court's desegregation decision of 1954 and the federal civil rights legislation of the 1960s. After another forty years, though, it is clear that the integrationist ideal has not fully triumphed in fact. Most Americans now probably acknowledge that racism is an evil, and blacks are visible in virtually every social, political, and economic arena; but race remains an axis of social stratification cutting across class lines. Racial ideology is frequently disguised in discussions of crime, welfare reform, and "Southern heritage"; and almost all social, economic, and health indicators continue to show blacks at a disadvantage. Myrdal's American Dilemma was republished after eighteen years at a moment of optimism as regards race relations, and an edited volume of thirteen essays revisited his work in a decidedly less sanguine 1996.¹ It may now be time to commission a new comprehensive study on race in America, with the goal of determining why we failed so miserably in the past half-century.

This was not the intention of Michael Byrd and Linda Clayton, and it is unfortunate that they chose to borrow the title of Myrdal's book for their own work. Rather, Byrd and Clayton—physicians with appointments at both the Harvard Medical School and the Harvard School of Public Health—wanted to explore the historical basis of the health deficit suffered by African Americans today.² To do so they traced the evolution of racial attitudes and health-care practices in Europe and adjacent regions, beginning with classical antiquity and continuing with the European conquest of North America and the place of Africans and their descendants within a society dominated by European-Americans. They undertook an ambitious survey of the literature, digested what they read, and attempted to present it in a clear narrative. For the work they put in, and for the...