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Susan Smith’s book addresses one of the most understudied aspects of African-American and American public health and medical history: the emergence of black health activism in the United States. She documents how blacks attempted to make the health needs of black America a legitimate political concern for the nation. She surveyed the period from the 1890s, when Prudential Life Insurance company statistician Frederick L. Hoffman heralded the impending extinction of the black population, to the 1950s, when black health professionals’ belief in integration brought to a premature end more than fifty years of efforts to ameliorate the poor health status of this group. Though Smith’s focus is explicitly on the public health efforts of black health professionals and lay groups, this book also implicitly reveals the ambiguous and ambivalent role played by the federal government in addressing the health-care needs of the poor for more than half a century. As a result it is an important contribution to studies of the origins of the current health-care crisis in the United States.
Black health reform was gendered, and Smith has done an outstanding job of documenting the “continuous, unbroken line of black women’s health activism since at least the 1890s” (p. 1). Contrasting black male leadership in the most prominent health reform effort—the National Negro Health Movement, with its signature program, National Negro Health Week—with the more local efforts of black midwives, public health nurses, and the Alpha Kappa Alpha sorority’s Mississippi Health Project, Smith shows the different strategies and emphases that black women brought to health work, versus those of black male physicians and dentists. Like their white male physician counterparts, black physicians gave a low priority to public health work. Black women, on the other hand, drew upon a long tradition of service to their communities, viewing health as indissolubly linked to the poverty and other socioeconomic factors that hindered black progress. While the contrast between the efforts of black male health professionals and of black women is striking, Smith gives us few details as to how the gendered and class aspect of black health reform affected the development and maintenance of health reform projects in black communities. Specifically, we learn that the move toward integration and the belief that separate health programs for blacks were a sign of inferiority grew among black health leaders by the 1950s, resulting in the closing of the USPHS’s Office of Negro Health Work and the disbanding of the National Association of Colored Graduate Nurses. However, we do not learn what brought about the decline, or perhaps shift, in the work of the black clubwomen and sororities most involved in grassroots health reform.
Drawing upon an impressive range of archival sources deposited at historically black colleges, and upon interviews and oral histories, Smith’s case studies of the work of black midwives, public health nurses, and sorority women support her [End Page 158] argument that black women played a key role in black health reform for much of this century. Her bibliographic sources will be extremely useful for scholars who want to delve more deeply into aspects of this history. As with all good social histories that break new ground, Smith’s book raises important questions deserving further study by historians of medicine and public health. How did racial politics affect public health practices in the South over the course of this century? And a related question: how did black health reform projects contribute to civil rights activity in the South and the rest of the country? One of the most important conclusions to be drawn from Smith’s excellent study is that blacks were not resigned to ill health. The tenuous success of the multifaceted efforts of black women health reformers attests not to their lagging commitment to improving the plight of their communities, but rather to the limits of self-help as...