Water, Race, and Disease (review)

For the last two, if not three, decades, a small but vocal group of African-American students has been subscribing to what could be termed "the golden age of segregation thesis"—the notion that the black community was unified, strong, and relatively content under de jure segregation. Indeed, they argue, the community deteriorated with desegregation. At first glance, Water, Race, and Disease seems to be supporting this view, but that clearly is not the case. The pivotal piece of information in this well-researched, convincing book is that during the "nadir"—from roughly 1880 to World War I, during the height of Jim Crow legislation and the worst race relations for African-Americans outside of slavery—the life expectancy of African-Americans actually increased. It did not do so during the quarter-century after the passage of the 1964 Civil Rights Act. What happened?

In a word, as Troesken shows, sanitation. Using a myriad of resources, including the Negro Mortality Project, he demonstrates that during the "nadir," African-Americans, like many white Americans, were suffering from the effects of water-borne and other related diseases—typhoid, yellow fever, kidney disease, and diarrhea. Because of the state of sanitation in most cities, North and South, these diseases easily spread: The yellow-fever epidemics in the South during the late nineteenth century were a prime example of the effects of the lack of sanitation.

During this era, African-Americans became increasingly defined as physically and morally inferior and as the carriers of these diseases. How can this reputation be averted? As Troesken amply documents, despite what most people believe about the era of Jim Crow, southern cities were not as residentially segregated as they are today. Hence, when cities decided to create water and sewage systems, African-Americans could not be excluded from the benefits without a large number of whites being excluded as well. Ironically, African-Americans benefited because white people wanted to avoid being contaminated by them, a clearly unintended consequence of municipal health reform. Troesken provides case studies of Memphis, Jacksonville, and Savannah to illustrate the connection between disease and the efforts to create water and sewage systems. Had Troesken not questioned certain basic assumptions, this major improvement in the quality of life for African-Americans might have remained unknown or been attributed to another cause.

Troesken's important book demonstrates once again that things are not always as they seem: Even conditions during the "nadir" were not as segregated as once believed, and "race" is such a convoluted notion that policies based on it often turn out to be convoluted as well. This book is highly recommended for those interested in studies of public policy, race relations, and public health.