Deluxe Jim Crow: Civil Rights and American Health Policy, 1935–54 (review)

“Deluxe Jim Crow” was the derisive phrase coined during the 1930s to protest projects that redressed disparities in services for black citizens while still maintaining racial segregation. This was on the way to Brown v. Board of Education, when the rubric “separate but equal” was still the law of the land. New Deal programs were preparing to modernize the U.S. health care system. Liberal politicians and racial justice activists debated whether they must demand immediate and full desegregation of health (and other) services or whether they might better serve the desperately marginalized Negro population by demanding parity between services for blacks and whites. This richly detailed and beautifully written book traces U.S. health policy from New Deal attempts at introducing racial justice into criteria for federal funding for social projects, through the Truman administration’s desegregation of the Armed Services (including the Veterans’ Administration hospitals), and into the McCarthy-era backlash. As massive hospital building projects focused on the South—identified as the region most in need of improved health care—need-based funding criteria favored black communities within the region, greatly improving both the numbers and the quality of hospitals and health care practitioners available to these communities. To gain political support for the legislation necessary to make these projects happen, New Dealers assured southern legislators that they would not be forced to relinquish Jim Crow racial barriers.

Was deluxe Jim Crow the last gasp of white supremacy segregation, or was it the first breath toward integration in health care services? Was it a loathsome compromise, or was it a strategy for moving toward racial equality? Thomas suggests that those who call these particular exclusionary practices racist display a “somewhat presentist misreading of the evidence” (25). She proceeds to tell the complex story of this important era by presenting the trajectories of individual careers, organizations, movements, debates, policies, and projects.

Thomas shows statistically and anecdotally how deluxe Jim Crow substantively improved the health of African Americans and poor Southern and rural whites and provided training for black health professionals. Although deluxe Jim Crow may have delayed the dismantling of the humiliating system, there is also strong evidence that it paved the way toward integration, as hospitals shifted from being separate and distinctly unequal facilities to being newly built edifices that were biracial but designed with separate wings for white and black patients. At the same time, black doctors had legitimate fears of institutional desegregation, which they could see would decrease support for Negro-only hospitals and practices. Charity cases, while paying less per capita than full-pay patients, provided a steady source of income for Negro hospitals and doctors before later amendments to the 1946 Hill-Burton Act’s funding regulation forced hospitals to accept patients without regard to race.

Although times have changed, today’s health care reform battles are informed by those of the past. Especially pertinent to our present-day struggles for universal health care is the story of how liberal politicians and advocates for social justice successfully posed federally supported health care as an issue of national security during World War II (when the South had the highest rate of rejections from Army draft because of poor health and illiteracy) and later during the Cold War. The Public Health Service and the National Institute of Health were originally chartered under the Federal Security Agency, which “defined racial discrimination as a problem of war production,” limiting needed access to “qualified Negro workers….” (121–22). Universal health care is true Homeland Security.

Is this an oral history–based book? Hardly. Deluxe Jim Crow is more likely to be compared to Paul Starr’s brilliant and thorough The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York, Basic Books, 1982) than to Remembering Jim Crow (New York, New Press, 2001). Deluxe Jim Crow was researched...