A Note from the Editor

At the time of this writing, the outcome of Congressional negotiations over health care reform remains uncertain. Anticipating the February 2010 publication of the present issue, we cast our eyes back to the U.S. health care system of 100 years past, especially as it related to minority groups and low-income populations generally. The roots of two central problems in 2010 reach all the way back to that time: the system then was already producing the fruit of (1) racial and ethnic health disparities, and (2) the problem of the uninsured that we know so well today. Unlike Western European countries, which were moving towards universal coverage at the beginning of the 20th century, the U.S. established a system in which health care was restricted along race and class lines. This medical apartheid, as Byrd and Clayton call it, arose from the increasing presence of Jim Crow laws and practices in the early 20th century and from the fact that policymakers did not adopt a general health insurance program as European countries did (and as Pres. Theodore Roosevelt advocated for the U.S.).^1–2

One hundred years later, the country has come a long way. The early 20th century was a time of widespread lynchings and race riots, a time when Black citizens—explicitly because of their race—often could not get health care at all, no matter how dire the consequences.^1,2 On May 31, 1921, the Tulsa race riots claimed the lives of hundreds (if not thousands) of Black citizens, including Dr. Andrew C. Jackson, a Meharrytrained physician and the state Vice President of the National Medical Association.^3,4 The two Black hospitals in Tulsa were burned down during the riots, leaving the Black citizens without a place where they might receive care. Our society is not so morally impoverished today.

We still eat the bitter fruit of race/ethnicity and class-based health disparities today, though, and the country's policymakers are only now moving towards a guarantee of health care for most (if not all). Perhaps, though, it is just as remarkable that we have moved so far from the ethically disastrous beginning of modern health care in the United States. Today, Black physicians (though far too few in number) have taken their place in the top ranks of the U.S. medical profession, overt race discrimination in care-giving is illegal, there is a network of effective federally qualified community health centers (though it is too small), and people from all backgrounds receive life-saving care at many good hospitals. As concerned people in the 21st century continue the work of eliminating race/ethnicity-based and class-based health disparities, it is good to be reminded of those who worked to the same end in a much more hostile environment, such as Dr. Jackson of Tulsa. Their courage and vision brought the country a very long way towards the goal of truly equitable care for all, a goal that may be within the grasp of the present generation.

The present issue opens with a photo essay created by Denise Stinson in collaboration with the members of a grandparents group. It celebrates the life-giving work of grandparents who put their own interests to one side in order to provide a loving home for their children's offspring. The Association of Clinicians for the -Underserved (ACU) Column in this issue addresses a central principle of that organization, trans-disciplinary care, and how health professions students can be trained to be effective members of a transdisciplinary care team. The opening Commentary concerns environmental justice: Shereitte Stokes, Darryl Hood, and colleagues review the case for the position that environmental toxins are disproportionately present in minority and low-income community and then present a step-by-step blueprint for organizing to prevent the establishment of toxic facilities in such areas. The authors' experience successfully fighting operation of a proposed coal-fired electrical power plant in Taylor County, Florida provides the case study underlying the blueprint. The rest of this Black History Month issue falls into three parts: Part 1—Policy; Part...